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

Preschool Participating Agreement
Registration Information:


Child’s Name:________________________________________________________________________ Mother’s Name: _______________________________Father’s Name:___________________________ Mailing Address:______________________________________________________________________ Telephone (day): ______________________________Telephone (eve):__________________________ E-Mail address: ____________________________________________ Hours and Fees: Childcare will be provided for the following: (circle all that apply) :00 - !:00 !:00 - 12:00 !:00 - 5:&0 "-F "-F "-F $ !"#month or "#$#F $$!#month or %#%H $%&#month $ (&#month $*&"#month

$!!"#month or "#$#F $'&!#month or %#%H $)""#month or "#$#F $%!"#month or %#%H

Contracted services are billed regardless of attendance. %he Parent#'uardian Agrees %o:  +ay an ann,al non-re-,nda.le $(% registration -ee/  Complete and s,.mit to the pres0hool a 0hild health -orm1 ,pdated ann,ally to age %1 an emergen0y in-ormation -orm1 and a general permission -orm/  Call .y $ a/m/ i- yo,r 0hild 2ill not .e 0oming -or the day/  3ave yo,r 0hild dressed and ready to play ,pon arrival/ +rovide a 0omplete 0hange o- 0lothing1 appropriate -or the 2eather1 to .e le-t at the pres0hool -or ,se 2hen needed/  +rovide alternate 0are in 0ase o- emergen0y -or instan0es 2hen the pres0hool is ,na.le to 0are -or yo,r 0hild 2itho,t advan0e noti0e/  +rovide alternate 0are in 0ase o- a 0ontagio,s illness or -ever1 and -or sno2 days and emergen0y 0losings/  4ign individ,al permission slips prior to -ield trips/  +rovide a healthy sna05 -or the 2hole 0lass on a rotating s0hed,le 2ith other parents/  4erve as a 0ooperative parent .y assisting the tea0hers and E6e0,tive Committee 2ith the operation1 maintenan0e d,ties and -,ndraising a0tivities to a0hieve the goals o- the pres0hool as o,tlined in the s0hool .yla2s/  7ive t2o 2ee5s noti0e i- yo, plan to disenroll yo,r 0hild/ (perating Policies:  "edication: 8- yo,r 0hild re9,ires the administration o- an) medi0ation .y the pres0hool sta--1 in0l,ding pres0ri.ed medi0ation as 2ell as over the 0o,nter medi0ines1 2e 2ill re9,ire *oth a 2ritten a,thori:ation signed .y the parent#g,ardian as 2ell as a 2ritten note -rom the 0hild’s li0ensed medi0al pra0titioner spe0i-ying the name omedi0ation1 dosage1 times to .e given1 and -or ho2 many days/ All medi0ation m,st .e in its original 0ontainer1 la.eled 2ith 0hild’s name and date/  %uition: T,ition is divided into ten monthly installments that 2ill .e .illed on the '%th o- the prior month and d,e .y the st o- the month/
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(perating Policies +ont,:  -ate %uition: A $'% late -ee 2ill .e assessed to -amilies 2hose t,ition payments are not re0eived .y the st o- the month and yo,r 0hild#0hildren 2ill not .e a.le to attend the program ,ntil yo,r a00o,nt is paid in -,ll/  +hanges to Participating Agreement: T2o 2ee5s noti0e is re9,ired -or all 0hanges/ ;p to t2o 0hanges per year per a00o,nt are allo2ed1 2ith an administrative -ee o- $ " per 0hange/ There is a $'" per 0hange -ee -or any additional 0hanges/  Pic.-up: +arents are responsi.le -or pi05ing ,p their 0hildren on time/ %here is a late pic.up fee of /5,00 for e0er) 15 minutes late, Comm,ni0ation is e6pe0ted/  Refunds: <e-,nds 2ill not .e made -or a.sen0es1 illness1 sno2 days or other emergen0y 0losings/ <e-,nds -or t,ition already paid 2ill only .e given 2ith t2o 2ee5s noti0e in 2riting to the treas,rer/  Additional +hildren: There is a dis0o,nt o- %"= -or the se0ond and s,.se9,ent 0hildren in a -amily 2ho are attending % days#25/ For anything less than % day enrollment the dis0o,nt is '%=/ %his discount is not applica*le to additional time,  Additional time: The rate -or pre-approved additional time is $(/"" per ho,r/  1ounced +hec.s: There 2ill .e a $'% -ee applied -or ret,rned 0he05s> m,ltiple o00,rren0es 2ill re9,ire that all -,t,re payments .e made in -,ll in 0ash/  1eha0ior: ?C+ reserves the right to dismiss any st,dent d,e to .ehavior iss,es (see @ehavioral +hilosophy)/  23itching: +arents may not s2it0h attendan0e days (.ring a MAF 0hild on T,esday instead o- Monday1 et0/)/ 8there is spa0e availa.le1 a parent may add an additional day at the additional time rate/  Pott) %raining: A00ording to state li0ensing g,idelines1 0hildren entering o,r program m,st .e toilet trained/

Parent 2ignature

4ate 2igned

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