*A non-refundable fee of $5 per child is required before application will be processed
Parent/Guardian 1’s Name:______Phone: ______
Address: ______
Email: ______Best method of contact: ⃞ email ⃞ phone
Parent/Guardian 2’s Name:______Phone: ______
Address: ______
Email: ______Best method of contact: ⃞ email ⃞ phone
Children’s Names Date of Birth (due date if expecting) Desired Start Date
______
______
______
⃞Prior enrollee ⃞Siblings must enroll together ⃞Sibling of a current enrollee ⃞Sibling of a prior enrollee
PROGRAMS & SCHEDULING OPTIONS: Every attempt will be made to fulfill your childcare needs; however, placement can’t be guaranteed by the desired start date.
Early Childhood Education School Age Programming-PEAK
Full Day at the Community Campus Kindergarten through 5th grade
Open 7:30am-5:30pm Before school: Available only at LittleHarbourDondero opens at 7:00
After school: 4:30 option available only at Little HarbourDondero
⃞M-F or ⃞MWF or ⃞T/TH After school: 6:00 option at Little Harbour, Dondero, New Franklin & Greenland Central School
_____Infant(8 weeks- 12 months) Please check which school:
_____Toddler(12 months-3 years) ___Little Harbour ___Dondero ___New Franklin ___Greenland
_____Preschool (3-6 years & Check the days and schedule needed (2 day minimum)
*must be fully potty trained) ⃞ M ⃞ TU ⃞ W ⃞ TH ⃞ F
_____Half-Day Preschool 9am-12pm ⃞ AM ⃞ 4:30PM ⃞ 6:00PM ⃞ AM & 4:30PM ⃞ AM & 6:00PM
(3-6 years & *must be fully potty trained) * If enrolling in the 4:30 program will you be utilizing the late bus: ⃞ YES or ⃞ NO
Located at the Dondero Elementary
School in Portsmouth
*Child is fully potty trained: ⃞ YES or ⃞ NO ____Summer PEAK(full day only 7:15am-5:30pm) ______
Help us to help you! From your income and family size, we can determine if you are eligible for tuition assistance.
Gross yearly income from all sources: ______Family size (all household members) ______
Important information: We welcome families to schedule a tour to learn more about our agency and our programs. Please call or email anytime to check on your status or to update any information. We do not call families until there is an opening available. If a space has been offered to you and you do not reply within 24 hours, we do move on to the next family. In addition, if we’ve made an offer more than once and you have passed on those offers, you will be removed from the list.
100 Campus Dr. Ste 20 Portsmouth NH 03801 (p) 603-422-8223 (f) 603-422-8227
OFFICE USE ONLY: Date application & fee received ______Amount received ______Cash / Check # ______