Child Information Record Form

*Required Fields (Number you would like your child to learn)

Mailing Information: (if different from street address)

Mother's Information

Father's Information

Who should we call first if your child needs to be picked up early due to illness?

Person(s) AUTHORIZED to pick up my child:

Second Person

Third Person

Fourth Person

Fifth Person

Person(s) who MAY NOT pick up my child:

First Person

Person(s) who MAY NOT pick up my child:

Second Person

Medical Information:

Please respond to the following questions by giving us as much background information as you can. We use this sheet to aid in observing and understanding your child.

Please list your child's favorites:

List the other children in your family:

First Sibling

Second Sibling

Third Sibling

Fourth Sibling

Fifth Sibling

If your child will be absent please contact the preschool at (435) 586-9368.

Preschool tuition is $500.00 per semester for mornings (5 days per week) or $450.00 per semester for afternoons (4 days per week). Tuition can be paid at the beginning of each semester, or in four monthly installments of $125/$112.50. Please notify Cassie if you will be paying by the semester or monthly.

We encourage you to make payments online at under the "fees" tab. This option is preferable due to easier tracking of payments.

If you are unable to pay online, payments can also be made at the cashier's office located in the Sharwan Smith Rotunda, however the guardian must provide SUU Preschool with a receipt.

Monthly due dates: September 4, 2012 October 1, 2012 November 5, 2012 December 3, 2012 January 7, 2013 February 4, 2013 March 4, 2013 April 8, 2013