New Student Enrollment

Complete Child Care Registration and Emergency Information

In this section you will complete all required child care licensing information.
Immersion Montessori School

Name of Child Care Program
CCCB-06980

License Number
TO THE PARENT OR GUARDIAN: This form must be completed for each of your children who will be enrolled in the program, and must be updated whenever information changes.
DATE OF CHILD'S ENROLLMENT*

MonthDayYear
Today's Date
IDENTIFYING INFORMATION OF PARENT/S OR GUARDIAN/S LEGALLY RESPONSIBLE FOR CHILD:
Name of Parent/Guardian #1*

First NameLast Name
Parent/Guardian #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1 Email Address*
example@example.com
Parent/Guardian #1 Phone Number*
Name of Parent/Guardian #2

First NameLast Name
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Email Address
example@example.com
Parent/Guardian #2 Phone Number
Indicate where parent/guardian above can be reached while child is in care. Include name, address and phone number of business if applicable. Include any special instructions, e.g. pager, cell phone, etc.
Parent/Guardian #1 Business Name*
Parent/Guardian #1 Business Hours*
Parent/Guardian #1 Business Address*
Special Instructions for reaching Parent/Guardian #1 during business hours*
Parent/Guardian #2 Business Name
Parent/Guardian #2 Business Hours
Parent/Guardian #2 Business Address
Special Instructions for reaching Parent/Guardian #2 during business hours
EMERGENCY CONTACT PERSON: You (parent/guardian) are required to list at least 1 person with whom you would feel comfortable leaving your child, and who could assume responsibility for your child if you could not be reached immediately in an emergency, or if for some reason you could not pick up your child and were unable to communicate with the program. Examples: if your child were sick and you were not accessible, or if you experienced sudden illness between work and picking up your child.
Emergency Contact #1 Name*

First NameLast Name
Emergency Contact #1 Relationship*
Emergency Contact #1 Address*
Emergency Contact #1 Phone number*
Emergency Contact #2 Name*

First NameLast Name
Emergency Contact #2 Relationship*
Emergency Contact #2 Address*
Emergency Contact #2 Phone number*

NON-EMERGENCY ALTERNATE PICK-UP PERSON/S:
I, {nameOf246}/{nameOf} authorize the following individual(s) to pick up my child from the program on a non-emergency basis.
Alternate Pick-Up #1 Name*

First NameLast Name
Alternate Pick-Up #1 Relationship*
Alternate Pick-Up #1 Address*
Alternate Pick-Up #1 Phone number*
Alternate Pick-Up #2 Name*

First NameLast Name
Alternate Pick-Up #2 Relationship*
Alternate Pick-Up #2 Address*
Alternate Pick-Up #2 Phone number*
NOTE TO PARENT/S or GUARDIAN/S: The licensing authority for this program is the bureau of licensing andcertification, child care licensing unit. Child care programs are required to post a copy of the statement of findings andcorrective action plan for the most recent visit in a location which is accessible to parents, and must maintain copies of thestatement of findings and corrective action plan for the preceding visit and make them available for parents to reviewupon request. Statements of findings and corrective action plans are also available on-line athttps://nhlicenses.nh.gov/verification/Search.aspx?facility='Y or by calling the unit at 603-271-9025 or 1-800-852- 3345,extension 9025. During visits to programs, licensing staff speak with children regarding the care they receive at the program if in the judgment of the licensing staff the children's response would be valuable in determining compliance with licensing rules. Licensing staff are experienced in working with children and trained to speak with children in a manner that is respectful and non-leading. Children will remain with their class or group during these conversations with licensing staff, and at no time will a child be forced to speak with a licensing coordinator. Please indicate whether licensing staff may speak with your child while they are with their class or group:

I give permission for child care licensing staff to speak with my child while with their class or group.I do not give my permission for child care licensing staff to speak with my child while with their class or group.
If licensing staff believes your child may have specific information regarding an alleged event at the child care program, and determines that it is best to interview your child separately and not with their class or group, please indicate your preference among the following options:

I give permission for child care licensing staff to interview my child at the child care program separate from their class or group.I wish to be notified prior to child care licensing staff interviewing my child at the child care program separate from their class or group.I do not give permission for child care licensing staff to interview my child at the child care program separate from their class or group. For more information about Child Care Licensing please visit our website at: https://www.dhhs.nh.gov/programs- services/childcare-parenting-childbirth/child-care-licensing
Allergies: List all known allergies (food, environmental, medication) and any required emergency treatment.*
Medical Conditions: Does the child have any ongoing medical conditions (e.g., asthma, diabetes, etc.) that could be important in case of sudden illness or injury?*
Medications: Is the child currently taking any medications? List the name, dosage, and schedule.*
Child's Usual Physician*
Physician's Address*
EMERGENCY MEDICAL TREATMENT AUTHORIZATION

I hereby give permission for the staff of Immersion Montessori School to provide simple first aid treatment to my child, {childsName} when necessary. In the event of a more seriousillness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility toreceive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment asis medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that I will be contacted by child care program personnel as soon as possible regarding any emergency involving my child.
Parent/Guardian Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date

State Licensing Requirements

Please complete the following state licensing requirements.
NOTE TO PARENT/S or GUARDIAN/S: The licensing authority for this program is the bureau of licensing andcertification, child care licensing unit. Child care programs are required to post a copy of the statement of findings and corrective action plan for the most recent visit in a location which is accessible to parents, and must maintain copies of the statement of findings and corrective action plan for the preceding visit and make them available for parents to review upon request. Statements of findings and corrective action plans are also available on-line athttps://nhlicenses.nh.gov/verification/Search.aspx?facility='Y or by calling the unit at 603-271-9025 or 1-800-852- 3345,extension 9025. During visits to programs, licensing staff speak with children regarding the care they receive at the program if in the judgment of the licensing staff the children's response would be valuable in determining compliance with licensing rules. Licensing staff are experienced in working with children and trained to speak with children in a manner that is respectful and non-leading. Children will remain with their class or group during these conversations with licensing staff, and at no time will a child be forced to speak with a licensing coordinator. Please indicate whether licensing staff may speak with your child while they are with their class or group:*

I give permission for child care licensing staff to speak with my child while with their class or group.I do not give my permission for child care licensing staff to speak with my child while with their class or group.
If licensing staff believes your child may have specific information regarding an alleged event at the child care program, and determines that it is best to interview your child separately and not with their class or group, please indicate your preference among the following options:*

I give permission for child care licensing staff to interview my child at the child care program separate from their class or group.I wish to be notified prior to child care licensing staff interviewing my child at the child care program separate from their class or group.I do not give permission for child care licensing staff to interview my child at the child care program separate from their class or group. For more information about Child Care Licensing please visit our website at: https://www.dhhs.nh.gov/programs- services/childcare-parenting-childbirth/child-care-licensing
(If Applicable) Download, Print, and Complete the Authorization to Administer Prescription and Non Prescription Medication Form
(If Applicable) Upload the completed Authorization to Administer Prescription and Non Prescription Medication Form

Cancelof
EMERGENCY MEDICAL TREATMENT AUTHORIZATION

I hereby give permission for the staff of Immersion Montessori School to provide simple first aid treatment to my child, {childsName} when necessary. In the event of a more seriousillness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility toreceive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment asis medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that I will be contacted by child care program personnel as soon as possible regarding any emergency involving my child.
Parent/Guardian Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date

Upload Required Documents
Upload your child's most recent immunization records.*

Cancelof
Upload your child's most recent annual physical exam.*

Cancelof

Additional Child Information for Personalized Care

To provide the highest quality care and tailored support, please complete the following questions to help us better understand your child’s unique needs, preferences, and family dynamics. This information allows our staff to create a nurturing, responsive environment for your child and to ensure a smooth integration into our program.
Preferred Child Name/Nickname*
Languages Spoken at Home: List all languages and the primary language.*
Previous Daycare or Preschool Experience: Has the child attended daycare or preschool before? If so, where and for how long?*
Siblings: Names and ages of siblings, and if they are enrolled in the program or elsewhere.*
Family Dynamics: Are there any special family circumstances, such as shared custody, recent moves, or recent changes?*
Cultural or Religious Practices: Any specific practices or holidays that the family observes that should be respected?*
Special Needs or Services Received: Has the child received any services (e.g., speech therapy, occupational therapy, counseling) in the past or currently?*
Dietary Restrictions: Any dietary preferences or restrictions (e.g., vegetarian, halal, gluten-free)?*
Temperament: How would you describe your child's temperament? (e.g., outgoing, reserved, active, etc.)*
Behavioral Triggers: Are there any specific things that upset the child or cause distress?*
Behavioral Strategies: Any strategies or comfort methods that help the child calm down when upset?*
Special Interests: Does the child have specific interests or activities they enjoy? (e.g., music, nature, art)*
Sleep/Nap Preferences: Does the child nap during the day? If so, what time and for how long? Any specific items needed for naps (e.g., blanket, stuffed animal)? Routine or ritual for falling asleep?*
Diapering and Toileting: Is the child in diapers, pull-ups, or toilet-trained? Any specific diapering preferences? Assistance needed for toileting, if trained?*
Eating and Mealtime Preferences: Are there foods the child particularly likes or dislikes? Any routines around mealtime (e.g., prefers to sit in a specific way or needs encouragement)?*
Morning Drop-Off Routine: Any particular preferences for drop-off, such as bringing a comfort item or a specific way of saying goodbye?*
Milestones: Are there any milestones the family is working on or has concerns about? (e.g., speech, motor skills, social skills)*
Special Developmental Concerns: Any concerns with development that have been discussed with a pediatrician or specialist?*
Support Needs: Does the child require additional support for any area of development?*
Sensory Sensitivities: Any known sensitivities (e.g., sensitivity to loud noises, certain textures, lighting)?*
Preferred Sensory Activities: Does the child have preferred sensory activities (e.g., likes to play with sand, enjoys water play)?*
Concerns or Goals: Are there any specific goals or concerns the family has regarding their child's time in care?*
Other Important Details: Any other information the family thinks is important for the staff to know about the child.*

Review Orientation Documents

Review the following orientation documents.
Family Handbook
Infant Program Information
Toddler Program Information
PreK Program Information
Elementary Program at Wonder Woods
Enrichment Programs
Please sign to acknowledge and confirm that you have reviewed the relevant documents above.*

Powered by Jotform SignClear

Permissions
Select Permissions to Grant

Walking Trips: I give permission for my child to participate in supervised walking trips around the campus, including on trails and nearby outdoor areas.Participation in Special Events: I give permission for my child to participate in special events organized by Immersion Montessori School, which may include celebrations, cultural events, or enrichment activities.Sunscreen Application: I give permission for staff to apply sunscreen to my child as needed, provided by the parent or purchased through the school.Bug Spray Application: I give permission for staff to apply bug spray to my child as needed, provided by the parent or purchased through the school.Special Treats and Celebrations: I give permission for my child to partake in occasional treats or special foods brought in for events, birthdays, or celebrations. I understand that the staff will need to exclude my child from participating if the food is not confirmed to being free of my child's allergens.Brightwheel Photos and Videos: I give permission for staff to share photos and videos of my child on Brightwheel, a secure platform for daily updates shared exclusively with families.School Training and Security: I give permission for Immersion Montessori School to use photos and videos of my child for training and security purposes within the school setting.Marketing and Promotional Materials: I give permission for Immersion Montessori School to use photos and videos of my child on the school’s website, social media platforms, newsletters, and other promotional materials. My child’s identity will remain anonymous, with no names or personal details disclosed.Field Trip Transportation: For any field trips I give permission for, I give permission for my child to be transported to and from field trip locations in approved vehicles including contracted bus services with proper safety seats/restraints and under staff supervision.
By signing below, I acknowledge that I have read, understood, and agreed to the permissions granted above. I also understand that I am responsible for notifying Immersion Montessori School of any changes to my child’s health, safety needs, or permissions as listed on this form.

Powered by Jotform SignClear

The Brightwheel App

Complete these steps to get set up and learn how to use the Brightwheel App, which is a school management software used by IMS families for the following: Daily communication with center staff (director, guides, assistant guides, etc., Receive notifications about snow days, closures, and other time sensitive alerts, Checking in and checking out students daily, Making bill payments.
Getting Started - Review the following videos for basic information on how to use Brightwheel. If you do not already have access to Brightwheel, please call Kaitlyn Friot at 603-359-6630 for assistance.
Set up Notifications

Please ensure that you have downloaded the app and have allowed for push notifications to be sent to your phone. This will allow for you to receive instant alerts, updates, and messages about your child.

Contract
Tuition and Payment

Billing and Due Dates:

Tuition is billed monthly via Brightwheel, due on the first of each month, with invoices sent 10 days in advance.

Rates and Adjustments:

Tuition rates are provided in the Family Handbook and may be adjusted annually with 30 days’ notice.

Late Fees:

Payments received after the due date may incur fees as outlined in the handbook.

Enrollment, Deposit, and Schedule

Program Selection and Hours:

Program, start date, and schedule are based on the enrollment selections made previously. Add-on selections including extended care, meal program, etc., will be made during billing setup and are also subject to the same 30-day adjustment notice period.

Deposit and Enrollment Commitment:

A nonrefundable deposit is required to secure enrollment and reserve your child’s space. This deposit confirms your commitment to begin care on the agreed start date and will be applied to the first month’s tuition once care begins.
- If a family chooses to cancel enrollment or delay the start date after the deposit has been paid, the deposit will not be refunded or credited, regardless of reason.
- If a family wishes to formally withdraw before the start date, a 30-day written notice may still be submitted; however, this does not affect the nonrefundable status of the deposit.
- IMS reserves the right to fill the reserved space if written cancellation is received, but the deposit will remain forfeited.
Cancellations and Withdrawals
A 30-day written notice is required for all withdrawals after enrollment begins.

Failure to provide this notice may result in additional tuition charges equivalent to up to one month’s tuition.

All outstanding balances must be settled at the time of withdrawal.

Refund Policy

Tuition refunds or credits are not provided for:
- Absences, vacations, or holidays
- School closures, weather-related closures, or emergency closures
- Schedule changes or reduced attendance by the family
- Cancellations made before the child’s start date (deposit is nonrefundable)
Subsidies and Financial Assistance
Families eligible for state subsidies or Child Care Aware® assistance are responsible for submitting required documentation promptly. Any portion of tuition not covered by assistance remains the family’s financial responsibility.

Program Policies

Admission Requirements:

All required documentation (immunization records, emergency contacts) must be submitted before the start date and updated as needed.

Attendance:

Consistent attendance is expected. Notify IMS in advance for planned absences, which do not qualify for tuition adjustments.

Drop-Off and Pick-Up:

Follow designated drop-off and pick-up times. Late pickups may incur a fee, as detailed in the handbook.

Nutrition Program:

IMS offers an optional meal program at an additional cost. Allergy and dietary needs are accommodated as specified in Brightwheel.

Health and Illness Policy:

Children showing signs of illness should remain home. IMS reserves the right to send a child home to protect community health based on applicable state licensing guidelines.

Discipline and Behavior:

IMS uses a Montessori approach, emphasizing positive reinforcement. Families are encouraged to align behavior expectations at home and school. IMS reserves the right to terminate enrollment if behavior or family interactions compromise school safety or program integrity.

Emergency Policies

Emergency Contact Information:

Families must keep emergency contact details current. IMS conducts regular emergency drills and will contact families promptly in case of an emergency.

School Closures and Weather Delays:

Notifications of closures or delays are sent via Brightwheel by 6:30 AM. Tuition is not adjusted for closures.

Agreement and Signature

By signing, I confirm that I have read and agree to abide by the policies in the IMS Family Handbook. I understand the expectations for payment, attendance, and behavior, and I support my child’s learning in alignment with IMS’s mission. I understand that the deposit is nonrefundable under all circumstances, even if my child does not begin care, and that a 30-day written withdrawal notice is required for all cancellations or withdrawals.
Signature*

Powered by Jotform SignClear
Should be Empty:

New Student Enrollment

Program Tuition, Add-Ons, and Assistance Information

Complete Child Care Registration and Emergency Information

Immersion Montessori School

CCCB-06980

IDENTIFYING INFORMATION OF PARENT/S OR GUARDIAN/S LEGALLY RESPONSIBLE FOR CHILD:

NON-EMERGENCY ALTERNATE PICK-UP PERSON/S:

State Licensing Requirements

Upload Required Documents

Additional Child Information for Personalized Care

Review Orientation Documents

Permissions

The Brightwheel App

Set up Notifications

Contract