1281 Main Street, Dublin, NH 03444 (603) 563-8508

Participating Agreement for Before School Services 2014-2015

Registration Information: Childs Name:________________________________________________________________________ Mothers Name: _______________________________Fathers Name:___________________________ Mailing Address:______________________________________________________________________ Telephone (day): ______________________________Telephone (eve):__________________________ E-Mail address: ____________________________________________ Ho rs an! "ees: Be ore s!hool !are "ill #e provided #et"een the ho$rs o %:&& AM and ':(& AM at a lat rate o )*&+&& per day+ M-F ),&&-month or M-.-F )*,&-month or T-T/ )'&-month (!ir!le one)

Contracted services are billed regardless of attendance, as this space is reserved for your child. #he Parent$% ar!ian Agrees #o: 0ay an ann$al non-re $nda#le registration ee o ),1+&& per !hild or )(1+&& per amily+ Registration fee waived for children who are enrolled in the preschool day program. Complete and s$#mit to the pres!hool a !hild health orm2 $pdated ann$ally to age 12 an emergen!y in ormation orm2 and a general permission orm+ Call #y % AM i yo$r !hild "ill not #e !oming or the day+ 0rovide alternate !are in !ase o emergen!y or instan!es "hen the pres!hool is $na#le to !are or yo$r !hild "itho$t advan!e noti!e+ 0rovide alternate !are in !ase o a !ontagio$s illness or ever2 and or sno" days and emergen!y !losings+ 0arents are responsi#le or !onta!ting the #$s !ompany in the event yo$r !hild "ill not re3$ire transportation to 4C5+ 5erve as a !ooperative parent #y assisting the tea!hers and e6e!$tive Board "ith the operation2 maintenan!e d$ties2 and $ndraising a!tivities to a!hieve the goals o the pres!hool as o$tlined in the #yla"s+ 7ive t"o "ee8s noti!e i yo$ plan to disenroll yo$r !hild+ &perating Policies: 'e!ication: 9 yo$r !hild re3$ires the administration o an( medi!ation #y the pres!hool sta 2 in!l$ding pres!ri#ed medi!ation as "ell as over the !o$nter medi!ines2 "e "ill re3$ire )oth a "ritten a$thori:ation signed #y the parent-g$ardian as "ell as a "ritten note rom the !hilds li!ensed medi!al pra!titioner spe!i ying the name o medi!ation2 dosage2 times to #e given2 and or ho" many days+ All medi!ation m$st #e in its original !ontainer2 la#eled "ith !hilds name and date+ # ition: T$ition is divided into ten monthly installments that "ill #e #illed on the ,1th o the prior month and d$e #y the *st o the month+ *ate # ition: A ),1 late ee "ill #e iss$ed to amilies "hose t$ition payments are not re!eived #y the *st o the month and yo$r !hild-!hildren "ill not #e a#le to attend s!hool $ntil yo$r a!!o$nt is paid in $ll+ +hanges to Participating Agreement: T"o "ee8s noti!e is re3$ired or all !hanges+ ;p to t"o !hanges per year per a!!o$nt are allo"ed2 "ith an administrative ee o )*& per !hange+ There is a ),& per !hange ee or any additional !hanges+
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&perating Policies +ont,: Ref n!s: <e $nds "ill not #e made or a#sen!es2 illness2 sno" days or other emergen!y !losings+ <e $nds or t$ition already paid "ill only #e given "ith t"o "ee8s noti!e in "riting to the treas$rer+ A!!itional time: The rate or pre-approved additional time is )%+&& per ho$r+ Bo nce! +hec-s: There "ill #e a ),1 ee applied or ret$rned !he!8s= m$ltiple o!!$rren!es "ill re3$ire all $t$re payments to #e made in $ll in !ash+ Behavior: 4C0 reserves the right to dismiss any st$dent d$e to #ehavior iss$es (see Behavioral 0hilosophy)+ S.itching: 0arents may not s"it!h attendan!e days (#ring a M.F !hild on T$esday instead o Monday2 et!+)+ 9 there is spa!e availa#le2 a parent may add an additional day at the additional time rate2 permission rom a tea!her is re3$ired and ,> ho$rs noti!e is appre!iated+

__________________________ Parent Signat re

__________________________ /ate Signe!