Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments.

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1 Brick Township Public Schools Brick Extended School Time Before and After School Care & Kindergarten Wrap Around 224 Chambers Bridge Rd - Brick, NJ ext BEST Program Families: Thank you for choosing the BEST Program for your before and after school care needs! We look forward to working with you to make this the BEST program for you and your child. Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments. (Daily rate x 180 school days)/10 months = your monthly payment Monthly tuition remains the same for each month regardless of holidays. Regular monthly rates apply to June as well. June is NOT prorated. Please also note that our monthly schedule forms do not always start and end on the first and last day of the calendar month. (Ex November s schedule starts on October 29) Thank you in advance for your cooperation! Sincerely, Ellen Tyndell Ms. Ellen Tyndell BEST Program Coordinator Please sign below acknowledging that you have read & understand the above information. I/We understand that my/our signatures represent that I/we understand that the monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments that are always due by the 15 th of the month before. And I/we also will note the start and end dates of each schedule form that we submit for our children. I/we also understand that monthly tuition remains the same for each month regardless of holidays and that June is NOT prorated. Signature of Parent/Guardian Date Signature of Parent/Guardian Date Print Name of Parent/Guardian Print Name of Parent/Guardian

2 Brick Township Public Schools Brick Extended School Time Before and After School Care Program Chambers Bridge Road - Brick, NJ ext Our goal for the Brick Extended School Time (BEST) Program is first and foremost to provide a safe environment for children, ages 5 14, of the Brick Public Schools, during out of school time. We center the program on offering developmentally appropriate activities that are fun and engaging for the children, at an affordable cost to their families BEST Monthly Rates Before School Care MONTHLY Rates 5 Days Per Week 4 Days Per Week 3 Days Per Week $105.00/Month $85.00/Month $65.00/Month After School Care MONTHLY Rates 5 Days Per Week 4 Days Per Week 3 Days Per Week $225.00/Month $180.00/Month $135.00/Month VMMS After School Care MONTHLY Rates 5 Days Per Week 4 Days Per Week 3 Days Per Week $280.00/Month $223.00/Month $167.00/Month The monthly payment plan requires a set schedule for each month and the same number of days per week. Monthly schedules and payments must be submitted by the 15 th of the month before (ex. December s schedule is due November 15 th ) Schedules and/or payments received after the 15 th of the month before will be charged a $25.00 late fee. Please give all monthly schedule forms to your child s Site Supervisor by the 15 th of the month before. Tuition is based on the number of State required school days (180 days) for the school year divided into ten equal monthly payments. (daily rate x 180 school days)/10 months = your monthly payment) Each family is entitled to one free schedule change per year. Additional schedule changes must be submitted in writing to the BEST Office and will incur a $20.00 fee. All scheduled early dismissal days are included in the monthly tuition at no additional charge. Please notify the BEST Program OFFICE, in writing, if you wish to discontinue use of the BEST Program for a period of time. Not submitting a monthly schedule form does NOT indicate to us that you are discontinuing use of the program. There are no credits, refunds, or adjustments for scheduled time not used in the BEST Program, due to school closings, personal vacations, absences, illnesses that last less than five (5) school days without a doctor s note, other school activities, program suspensions, etc. The only exception to this policy is in the case of an extended illness, whereby, the student has missed five (5) consecutive days of school or more and is documented by a doctor s note; a credit will be applied to your child s account. A discount will be given to families with multiple children living in the same household that are registering in the BEST Program. Full tuition 1 st child, 10% discount 2 nd child, 20% discount additional children Parents-In-A-Pickle Rates Before School Care -- $10.00/Day After School Care -- $20.00/Day Early Dismissal Days -- $30.00/Day Students MUST be registered in the BEST Program prior to using the Parents-In-A-Pickle Plan. If using the After School Care Program on the Parents-In-A-Pickle Plan, the BEST Office and your child s school must be contacted prior to 12:00PM (noon) of the day you need your child to attend. Parents-In-A-Pickle days can be scheduled in advance. Parents-In-A-Pickle rates are due on the same date of service. Parents-In-A-Pickle rates are not subject to sibling discounts.

3 BEST Program Elementary Schools Registration Child Registration Form Please complete a separate registration packet for each child and return to the BEST Office at the PLC. A $25.00 Registration Fee per child is due at time of registration. Please make checks payable to the BEST Program. Sex: M F Student s Last Name Student s First Name Birth Date Grade Street Address City State Zip Date your child will be starting the BEST Program: School: Drum Point Emma Havens Herbertsville Lanes Mill Midstreams Osbornville VMES VMMS Housing Status: Student lives with: Both Parents Mother Father Foster Parents Court Appointed Guardian Other FAMILY INFORMATION Parent 1 Parent 2 Mother Father Step-Mother Mother Father Step-Mother Step-Father Other Step-Father Other Name Address (if different from above) Name Address (if different from above) Home Phone Cell Phone Home Phone Cell Phone Employer & Occupation Employer & Occupation : - : : - : Work Phone Work Hours Work Phone Work Hours Address Address RELEASE INFORMATION Please list three (3) additional adults (over the age of 18) that are authorized to remove your child from the program and who the BEST Program can contact in case of an emergency. In an emergency situation, we will always try to contact the parents listed above first. If we cannot reach the child s parents, the individuals below will be called in the order listed. 1. Name Address (city, state) Phone Relationship 2. Name Address (city, state) Phone Relationship 3. Name Address (city, state) Phone Relationship Optional family secret code word: Used to verify your identification on the phone.

4 CHILD S FULL NAME: Adults, including separated or divorced parents, who are NOT authorized to remove the child from the program: 1. YES NO Name Relationship to Child Court Documents Attached 2. YES NO Name Relationship to Child Court Documents Attached MEDICAL INFORMATION Doctor s Name Phone Dentist s Name Phone There is NO nurse available during the BEST Program. Medication may not be given by our staff, including inhalers. Does your child have any medical conditions? Yes No Describe: Does your child have any food/medical allergies? Yes No Describe: Please list any special needs/behaviors or any other information that would be helpful to staff that we should be aware of: AUTHORIZATIONS I understand that my child is ONLY allowed to leave the BEST Program with an adult who is at least 18 years of age who provides picture identification to the BEST staff at my child s school. I also understand that an authorized adult is ONLY someone whose name has been listed with the BEST Office. (Initial) I give permission for my child to appear in any media coverage (Newspaper, TV, District Website, etc.) approved by the BEST Program. The BEST Program will NOT list children s names on any media coverage. Yes No I give permission for my child to watch G or PG rated movies at the BEST Program. Yes No I/We understand that my/our signatures represents that I/we agree to abide by the policies and procedures as in the BEST Parent Handbook and accept financial responsibility for services rendered. I/We agree to inform the BEST Program, in writing, of any changes in the information we have provided on this registration form, as well as changes to our child s BEST Program schedule. Signature of Parent/Guardian Date Signature of Parent/Guardian Date _ Print Name of Parent/Guardian Print Name of Parent/Guardian

5 BEST Program Consent Form School Year Child/Children Name(s) I agree that I have read and will follow the rules and procedures in the BEST Parent Handbook available online at and in print by request. I agree to assume full responsibility for any damage to school property caused by my child. My child is expected to attend the BEST Program every day that she/he is scheduled. I will notify the BEST Office, my child s school office, and my child s teacher when there is a change to my child s BEST Program schedule. All points of contact must be made each time there is a change in your child s BEST schedule. In addition, chronic offenders will be terminated from the program. Any day that my child does not attend school, she/he cannot attend the BEST Program. I understand that if my child has a persistent pattern of negative behavior, and interventions have not been successful, I may be asked to remove my child from the BEST Program. No refunds will be issues. Based on the magnitude of a behavioral incident, my child can be withdrawn from the BEST for an appropriate amount of time beginning the day after the incident. An accumulation of incidents may result in my child s termination from BEST for the rest of the school year. I confirm that my child is in good health and able to participate in the BEST Program s activities. I understand that a nurse is not available during the hours of operation of the BEST Program. I also understand that medication, including prescription and nonprescription drugs, cannot be administered by staff in the BEST Program. I agree that, if it is determined that my child needs emergency medical or dental treatment; I will be responsible for any such treatment deemed necessary by a physician or dentist. Accident Insurance is available for me to purchase and is available through the main office and District Board Office. Emergency Medical Release: If emergency medical care is deemed necessary and I cannot be contacted, I authorize the BEST Program staff to act on my behalf in granting permission for my child to receive emergency treatment. I agree that if the behavior or health of my child should make it necessary to send him/her home, I, or an emergency contact person, will immediately pick up my child from the program. Unpaid bills, even for those children no longer attending, will be turned over to the District Business Administrator s Office for payment and small claims court proceedings will be filed. As per District Policy #5843, a fee of $25.00 will be applied to your account if balances are delinquent for two (2) or more weeks. If after two weeks the balance is not paid, the child will be terminated from the program. I agree to record my signature on the attendance sheet each time I drop off and/or pick up my child from the BEST Program. I understand that for the before school program, my child cannot be signed into BEST until 6:30 A.M.

6 My child must be picked by 6:00 P.M. from the after school program. Pick-up after 6:00 p.m. is considered a LATE pick-up. Late pick-ups between 6:01 6:15 P.M. will incur a late fee of $15.00; 6:16 6:30 P.M. the late fee is $30.00; 6:31 6:45 PM the late fee is $ In the event that you will be late, please contact your emergency pick-up designee to pick up your child, and thus, avoid the late fees. Please also call your child s program site cell phone to inform our staff that you are running late and/or that someone else will be picking up your child. In addition, chronic offenders may be terminated from the program. My child is not allowed to leave the BEST Program unless picked up by an adult who shows our staff picture identification and who is listed on my child s authorized pick-up list which is on file with the BEST Office. An authorized adult is ONLY someone 18 years of age or older whose name has been listed on your child s authorized pick-up list with the BEST Office. If my child has not been picked up by 7:00 P.M., the Brick Township Police Department will be contacted. The BEST Program will not reimburse families for tuition payments or credit families for unused before or after school program days. The only exception to this policy would be in the case of extended illness, whereby, the student has missed five (5) or more consecutive days of school, all of which must be substantiated by a physician s written note. I agree to give one week advance written notice when withdrawing my child from the program or changing the program plan. Late/Non-Payment and Bounced Check Fee Policies: In the event that the check that I provide to the BEST Program for payment of services is returned for insufficient funds/closing of an account or any other reasoning, I will be charged a $25.00 fee, in addition to the original amount due. After one returned check, I will only be allowed to pay for the BEST Program services via cash or a money order. In the event that above happens and restitution is not made or non-payment of BEST Program services occurs, and this amount due is sent to collection, I will be responsible for the original debt together with all accrued finance and collection charges, court costs and attorney s fees, which are allowed by law. I have read, understand, and agree to abide by all the above. Signature of Parent/Guardian Date Print Name Signature of Parent/Guardian Date Print Name

7 BRICK TOWNSHIP PUBLIC SCHOOLS BEST Program x 1531 Elementary Schools MONTHLY PAYMENT PLAN MONTH: SEPTEMBER 2012 **REMINDER! - PAYMENTS AND SCHEDULES ARE DUE BY AUGUST 16 th in order for your child to start the BEST Program on the first day of school. ** CHILD S NAME: CHILD S SCHOOL: BEFORE SCHOOL CARE SCHEDULE: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SCHOOLS SCHOOLS AFTER SCHOOL CARE SCHEDULE: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SCHOOLS SCHOOLS TOTAL COST FOR BEFORE SCHOOL = $ BEFORE SCHOOL CARE 5 DAYS PER WEEK = $105.00/Month TOTAL COST FOR AFTER SCHOOL = $ 4 DAYS PER WEEK = $85.00/Month 3 DAYS PER WEEK = $65.00/Month SUBTOTAL $ DISCOUNT APPLIED - $ AFTER SCHOOL CARE 5 DAYS PER WEEK = $225.00/Month $25.00 LATE FEE IF RETURNED 8/15 $ 4 DAYS PER WEEK = $180.00/Month 3 DAYS PER WEEK = $135.00/Month TOTAL AMOUNT DUE $

8 BRICK TOWNSHIP PUBLIC SCHOOLS BEST Program x 1531 Elementary Schools PARENTS-IN-A-PICKLE PLAN MONTH: SEPTEMBER 2012 CHILD S NAME: CHILD S SCHOOL: BEFORE SCHOOL CARE SCHEDULE: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SCHOOLS SCHOOLS AFTER SCHOOL CARE SCHEDULE: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SCHOOLS SCHOOLS TOTAL COST FOR BEFORE SCHOOL = $ BEFORE SCHOOL CARE $10.00 PER DAY TOTAL COST FOR AFTER SCHOOL = $ AFTER SCHOOL CARE $20.00 PER DAY SUBTOTAL $ EARLY DISMISSAL DAYS $30.00 PER DAY TOTAL AMOUNT DUE $