TREASURE ISLAND REGISTRATION

Preschool Treasure Island

Ages 4 and up

Wednesdays 1-2pm

Oct. 4 - May 22, 2024

Suggested Donation $100

Treasure Island (K-5)

Wednesdays 2:45-5pm*

*Pick Up Available from Pali (2:40) and Village (3:00)

Sept. 13, 2023 - May 22, 2024

Suggested Donation $100

TREASURE ISLAND REGISTRATION FORM

Please type N/A for any field that does not apply to you.

Program Selection

Which Treasure Island group will your child be attending?

Preschool Treasure Island (Wed 1-2pm)

Treasure Island K-5 (Wednesdays 3-6)

Child's Name

First Name

Last Name

Child's Age

Child's Birthdate

YYYY

Grade or Classroom

Please indicate child's grade level or preschool room color.

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

Note: Please only use numbers for this entry. No other characters allowed.

Parent Name

First Name

Last Name

Cell Phone

Note: Please only use numbers for this entry. No other characters allowed.

Parent Name

First Name

Last Name

Cell Phone

(###)

###

####

Other Emergency Contact

First Name

Last Name

Emergency Contact's Phone Number

Note: Please only use numbers for this entry. No other characters allowed.

Doctor's Name

First Name

Last Name

Doctor's Phone Number

Note: Please only use numbers for this entry. No other characters allowed.

Allergies

Please list any allergies your child may have.

After Program Pick Up

Please list the names of anyone other than a parent who is authorized to pick your child up:

Elementary School Pick Up

If you’re enrolling for Treasure Island (K-5) and attend Pali Elementary or Village Schools, please indicate which school or that your child doesn't need to be picked up.

Pali Elementary

Village School

My child does not need to be picked up from school.

School Pick Up Authorization

If we will be picking your child up from school, please initial below to indicate that we have permission to do so.

Teacher's Name

For pick-up, please list your child’s teacher name and contact the school to let them know that they will be picked up by Joey Hargrove with Treasure Island on Wednesdays.

Further information will be provided upon registration. Please email Joey Hargrove (joeydh@aol.com) with any questions.

TREASURE ISLAND REGISTRATION

Please type N/A for any field that does not apply to you.