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August 1st, 2016 Dear Chartwell Parents: While your child is blissfully enjoying the lazy, hazy days of summer, here at Chartwell we are busily preparing for our first day of school on Monday, August 22nd. We look forward to seeing all returning students and welcoming new students who will be joining us this fall. Included in your fall packet is everything you need to know about uniforms, supplies, daily schedule, and calendar as well as the important forms we need signed and returned to complete your enrollment. We made a concerted effort this year to consolidate and reduce the number of forms to sign. The most current student roster is included to facilitate families in forming carpools, and this will be updated as late enrollments occur. You will also find the revised Chartwell Family Handbook for you to read and review with your child, then sign and return the Handbook Acknowledgement Agreement and all forms by Monday, August 15th. Many of the separate policy forms sent home in previous years now only require you and your child to initial on the Handbook Acknowledgement form to indicate your agreement. Regarding the uniform dress code, please take a few moments to write your child's name on the label of all clothing, lunchboxes and backpacks to help us identify lost items. We request that all students arrive on the first day of school with a sturdy binder (2” for grades 2 – 4, and 3” for grades 5 – 8), a three-‐hole pencil pouch with extra pencils, erasers and highlighter pen. Chartwell will provide all students with 6 preprinted subject dividers, an Assignment Book and a Plastic Pocket page for communication between school and home on the first day. Students will not need large amounts of binder paper as individual language teachers will provide specialized paper for students in their classes. All students should bring a snack and a bag lunch every day of the school year. Please review the Food/Nutrition guidelines in the Family Handbook. Students should not bring carbonated sodas, drinks with high levels of sugar or caffeine, candy, gum or chocolate (including milk). The school is unable to refrigerate or heat up lunches for students, but we keep emergency supplies on hand in the event a student forgets to bring a lunch. Please arrive at Chartwell by 8:15 on Monday, August 22nd. At that time, we will all meet on the basketball court (or in McMahan Hall in case of rain) to welcome our students and divide into homerooms. School dismisses at 3:00 p.m. every day, except Fridays, which have a 2:00 p.m. dismissal time. I hope students enjoy every last moment of their summer break to the fullest but come prepared and excited for the new school year. As always, please do not hesitate to contact me if you have any questions. Best regards,
Steve Henderson Head of K8
CHARTWELL SCHOOL K-8 Calendar 2016-2017 August 2016 February 2017
S M T W T F S S M T W T F S
1 2 3 4 5 6 1 2 3 4
7 8 9 10 11 12 13 5 6 7 8 9 10 11
14 15 16 17 18 19 20 12 13 14 15 16 17 18 20 NO SCHOOL Presidents’ Day Observed NO SCHOOL
21 22 23 24 25 26 27 15 Teachers Return 19 20 21 22 23 24 25 22 - 24 Parent Conferences 12:00 PM Dismissal
28 29 30 31 22 Students return 26 27 28
Days 8 Days 19
September 2016 March 2017
S M T W T F S S M T W T F S
1 2 3 1 2 3 4
4 5 6 7 8 9 10 7 NO SCHOOL - Labor Day 5 6 7 8 9 10 11
11 12 13 14 15 16 17 14 Back to School Night 12 13 14 15 16 17 18 17 Grandparents Day 12:00 PM Dismissal
18 19 20 21 22 23 24 19 20 21 22 23 24 25 20 - 31 NO SCHOOL Spring Break Spring Break
25 26 27 28 29 30 26 27 28 29 30 31
Days 21 Days 14
October 2016 April 2017
S M T W T F S S M T W T F S
1 1
2 3 4 5 6 7 8 7 NO SCHOOL - Inservice Day 2 3 4 5 6 7 8 3 Students Return
9 10 11 12 13 14 15 10 NO SCHOOL - Columbus Day Observed
9 10 11 12 13 14 15
16 17 18 19 20 21 22 26 - 28 Parent Conferences 12:00 PM Dismissal
16 17 18 19 20 21 22
23 24 25 26 27 28 29 23 24 25 26 27 28 29
30 31 Days 19 30 Days 19
November 2016 May 2017
S M T W T F S S M T W T F S
1 2 3 4 5 1 2 3 4 5 6 5 NO SCHOOL - Inservice Day
6 7 8 9 10 11 12 7 8 9 10 11 12 13
13 14 15 16 17 18 19 11 NO SCHOOL - Veterans Day Observed
14 15 16 17 18 19 20
20 21 22 23 24 25 26 23 - 25 NO SCHOOl Thanksgiving Break
21 22 23 24 25 26 27
27 28 29 30 28 29 30 31 29 NO SCHOOL Memorial Day Observed
Days 18 Days 20
December 2016 June 2017
S M T W T F S S M T W T F S
1 2 3 5 Pear Tree Fundraiser 1 2 3 31-2 Parent Conferences 12 p.m. Noon Dismissal
4 5 6 7 8 9 10 4 5 6 7 8 9 10 2 Last Day of School 12 p.m. Noon Dismissal
11 12 13 14 15 16 17 16 Dorothy’s Kitchen Event 12:00 PM Dismissal
11 12 13 14 15 16 17 12 Summer School Begins
18 19 20 21 22 23 24 19 – 1 NO SCHOOL Holiday Break
18 19 20 21 22 23 24
25 26 27 28 29 30 31 25 26 27 28 29 30
Days 12 Days 3
January 2017 July 2017
S M T W T F S S M T W T F S
1 2 3 4 5 6 7 1 4 NO SCHOOL Independence Day Observed
8 9 10 11 12 13 14 3 Students Return 2 3 4 5 6 7 8 7 Last day Summer School
15 16 17 18 19 20 21 9 10 11 12 13 14 15
22 23 24 25 26 27 28 16 NO SCHOOL Martin Luther King Day
16 17 18 19 20 21 22
29 30 31 29 – Inservice Day, 12 PM Dismissal
23 24 25 26 27 28 29
Days 19 30 31 Days
Total School Days: ? Green—School Functions Academic Weeks: ? Red—No School/Vacation Blue— 2:00 p.m. Friday Early Dismissal
8:15 – 8:22 Homeroom
8:25 – 9:10 1st Period Class
9:15 – 10:00 2nd Period Class
10:00 – 10:20 Morning Recess
10:25 – 11:10 3rd Period Class
11:15 – 12:00 4th Period Class
12:00 – 12:30 Lunch A – Elementary School Students
12:30 – 1:00 Lunch B – Middle School Students
1:00 – 1:15 Silent Reading *
1:20 – 2:05 5th Period Class **
2:10 – 2:50 6th Period Class
2:50 – 3:00 Homeroom & Dismissal ***
* Elementary School Assembly on TUESDAY – 1 PM McMahan Hall
** FRIDAY is early dismissal at 2 PM
Students return to homeroom at 1:55 PM from Period 5
*** After-School Homework Program from 3 PM – 5 PM
Monday – Thursday (no program on Friday)
K8 DAILY SCHEDULE
CHARTWELL SCHOOL
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National Customer Service:800.854.6951Hours (Pacific Time):
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Mon-Fri 8am - 5pmExtended hours in July August
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FAX: 877.291.5480135 SE Hawthorne BoulevardPortland, OR 97214
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Order forms available online.1282 Oddstad DriveRedwood City, CA 94063(650) 299-9623
Tuesday-Thursday 11am - 6pmFriday 11am-3pmSaturday 10am - 2pmLabor Day 10am - 2pm
August onlyMonday - Friday 11am-6pmSaturday 10am - 5pm
REGULAR STORE HOURS:
EXTENDED SUMMER HOURS:
Acknowledgement of Handbook
& Agreement of Conduct
Student’s Name: _____________________________________________________________________________
Acknowledgment of Receipt and Review of Family Handbook
By signing this form, I acknowledge that I have received the Chartwell Family Handbook and understand that it contains important information on Chartwell School’s general policies, rules, regulations and obligations as a Chartwell family. I acknowledge that I am expected to read, understand, and adhere to these policies and familiarize myself with the material in the handbook. I understand that it is my responsibility to review the information contained in this handbook with my Chartwell child. I further understand that Chartwell School may change, rescind or add to any policies or practices described in the handbook. Chartwell School will advise families of changes within a reasonable time, and I agree to abide by any new or revised policy. Please initial that you and your child understand and agree to the following Chartwell School policies: Lower & Middle School Students Parent Student
_____ _____ Code of Conduct
_____ _____ Emergency/Disaster and ParentReach Network
_____ _____ Student Technology Terms of Use
_____ _____ Cellular Phones/Communication
_____ _____ Library Use Agreement
_____ _____ iPod Use Agreement (grades 6-‐8 only)
High School Students Parent Student
_____ _____ Standards
_____ _____ Computer Use and Conduct
_____ _____ Standards for Dances, Social Gatherings, Field Experiences
_____ _____ Safety and Emergency Procedures, Risk and Indemnification, Access, School Messenger
______________________________________________ ________________________________ Student Signature Date ______________________________________________ ________________________________ Parent / Guardian Signature Date
CHARTWELL SCHOOL
Emergency Contact Form
STUDENT INFORMATION
Child's Name: ____________________________________________________________ □ Female □ Male First Middle Last Home Address: ____________________________________________________________________________ Street Number and Name Apartment Number PO Box ____________________________________________________________________________ City State Zip Code Home Telephone: ____________________________ Date of Birth (mm/dd/yy): ____________________
PARENT 1 INFORMATION
Parent 1 Full Name: _____________________________________________________________________________ First Middle Last Mailing Address: _____________________________________________________________________________ (if different than child's) Street Number and Name Apartment Number PO Box _____________________________________________________________________________ City State Zip Code Parent 1 Cell Phone: _______________________ Parent 1 Email: _____________________________________
PARENT 2 INFORMATION
Parent 2 Full Name: _____________________________________________________________________________ First Middle Last Mailing Address: _____________________________________________________________________________ (if different than child's) Street Number and Name Apartment Number PO Box _____________________________________________________________________________ City State Zip Code Parent 2 Cell Phone: _______________________ Parent 2 Email: _____________________________________ EMERGENCY CONTACT INFORMATION (If the school is unable to establish contact with a parent during an emergency or illness, list relatives or friends who are able to act on your behalf)
Name #1: _____________________________________________ Phone: ___________________________ Relationship to Child: _________________________________________________________________________ Name #2: _____________________________________________ Phone: __________________________ Relationship to Child: _________________________________________________________________________ PERSON AUTHORIZED TO PICK UP CHILD AT SCHOOL (other than parents & include carpool drivers)
Name #1: _____________________________________________ Phone: ___________________________ Relationship to Child: __________________________________________________________________________
CHARTWELL SCHOOL
Name #2: ________________________________________ Phone: _________________________________ Relationship to Child: __________________________________________________________________________ PHYSICIAN INFORMATION Name: ____________________________________ Phone: ____________________
DENTIST INFORMATION Name: _____________________________________ Phone: ____________________
MEDICAL AUTHORIZATION
_______ I hereby grant Chartwell School permission to take whatever action may be necessary in supplying emergency medical services to my child. I understand that Chartwell will attempt to contact and follow the instructions of the parent/guardian, physician or other persons designated as emergency contacts. In the event that Chartwell is unable to contact any of the above persons, I hereby grant permission to Chartwell to contact and comply with the advice of an available physician, ambulance personnel or emergency room personnel. I hereby agree to be solely responsible for and will pay any expenses that may be incurred by Chartwell in making emergency medical treatment available to my child.
PRESCRIPTION MEDICATION
_______ My initials authorize Chartwell to dispense prescription medication to my child. Chartwell will only dispense prescription medication in the original pharmacy bottle with the child’s name, dosage, doctor’s name, and date on it.
Medication #1: ________________________ Dosage: (Amount)_____________ Time: ____________ Reason: ____________________________________________________________________________
Medication #2: ________________________ Dosage: (Amount)_____________ Time: ____________ Reason: ____________________________________________________________________________
OVER-‐THE-‐COUNTER MEDICATION
I authorize Chartwell School to dispense the following over-‐the-‐counter medication(s) to my child as needed: (check all that apply)
Acetaminophen _____ Ibuprofen _____ Tums_____ Cough drops_____ Other medication:_________________ Please provide any additional pertinent information: ___________________________________________________
MEDICAL INSURANCE CARRIER INFORMATION
Name: _____________________________________________ Policy Number: _____________________
• Please explain any allergies or dietary restrictions that your child has (include allergies to medications):
__________________________________________________________________________________________
• Please explain any medical conditions that your child has that the school needs to be aware of:
___________________________________________________________________________________________
Parent / Guardian Signature: ________________________________________ Date: ________________________
Permission & Release Form
Student’s Name: ___________________________________________________________________________________
(Please initial each relevant section to indicate that you grant permission)
SCHOOL ROSTER _______ Chartwell School provides every family with a school roster containing contact information for each student, including the student’s name, parent names, home address, home phone, cell phone and email address. Information included on the roster is to be used for school purposes only. Please list any contact information that you DO NOT want published on the school roster and shared with other parents:
__________________________________________________________________________________________________ __________________________________________________________________________________________________ WEEKLY THURSDAY MESSAGE _______ Chartwell is a green school and makes every effort to reduce paper usage, therefore the Head of School sends a Weekly Message to parents by EMAIL. It’s important for parents to read the message, as there are often permission forms and information regarding special events.
REVIEW OF RECORDS _______ I hereby acknowledge and consent to the review of my child’s permanent records by the State of California, County of Monterey, and/or local school district for purposes of accreditation or assessment.
PLAY EQUIPMENT AND SCHOOL ACTIVITIES ______ I hereby grant permission for my child to use all of the play equipment and participate in all school activities.
Parent / Guardian Signature: ___________________________________________ Date: ___________________
CHARTWELL SCHOOL
Image Release Form
Student’s Name: ______________________________________________________________________
PERMISSION TO USE STUDENT’S PHOTOGRAPH Chartwell School may use images of Chartwell students on bulletin boards, educational publications, social media or in general media releases on a controlled basis. Any images would highlight the students either demonstrating learning techniques or participating in approved school activities. I understand that this signed Image Release Form shall be effective during the entire period of my child’s enrollment at Chartwell School unless parents advise otherwise in writing.
PARENT AUTHORIZATION ____ I/We consent to the use of my child’s image; use may include all Chartwell publications (print, brochures, website, video, etc.). Photographs would highlight the students either demonstrating learning techniques or participating in approved school activities. ____ I/We DO NOT consent to the use of my child’s image for any Chartwell publication (print, brochures, website, video, etc.), with the exception of the Chartwell School Yearbook.
Parent / Guardian Signature: ______________________________________ Date: ______________
CHARTWELL SCHOOL
Volunteer Vehicle Use Policy
Student’s Name: ______________________________________________________________________
Individuals who voluntarily drive for school events must: • maintain a current, valid California driver’s license • ensure proper vehicle insurance coverage • be enrolled in the Department of Motor Vehicles Pull Notice Program (DMV – EPN) • understand their liability in the event of an accident
These measures have been implemented to ensure our students are in the hands of safe, responsible, and knowledgeable drivers. Department of Motor Vehicles Pull Notice Program The DMV – EPN Program allows Chartwell to monitor the driving records of volunteers who drive on behalf of Chartwell lower, middle and high school, to ensure the safety of our students. The DMV – EPN Program provides Chartwell with a copy of the volunteer’s driving record upon enrollment, and at any time that an action has been added to his/her driving record, including convictions, failures to appear, accidents, and driver license suspensions or revocations. Volunteer drivers shall have no more than three (3) driving record points for moving violations (speeding, failure to stop, etc.) and no major violations in the previous three (3) years, including alcohol or drug related driving offenses. Volunteer Driver’s Acknowledgement & Waiver of Liability I certify that as a volunteer driver for any school event I will adhere to the following: 1. I will have a valid driver’s license in my possession in accordance with California State law, and my driving record has fewer than three (3) driving record points for moving violations, no major violation in the previous three (3) years, and I have not been convicted of any alcohol or drug related driving offense in the past three (3) years. 2. I am in possession of an automobile insurance policy that provides at least $100,000/$300,000 bodily injury and $50,000 property damage, or $300,000 combine single limit (CSL). 3. I will have my current vehicle registration and proof of insurance in the vehicle at all times while driving, as required by Vehicle Code Section 16020.
CHARTWELL SCHOOL
4. I will carry only passengers who are on Chartwell business or student trips. 5. The vehicle used will be equipped with safety belts in good operating condition and all passengers will be required to wear them. 6. The vehicle I drive will be in safe mechanical condition as required by law, and I will perform the appropriate safety checks as needed prior to the field trip. 7. I understand that in the event of an accident, my insurance will be the primary insurance, and that the school cannot be held liable or accountable for any accident caused by me, to me or to my passengers. I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available my driving record to Chartwell School. I understand the school will enroll me in the Pull Notice (EPN) program in order to receive a driver record report at least once every 12 months and notification of any subsequent convictions, failures to appear, accidents, driver license suspensions or revocations, or any other action taken against my driving privilege. I understand that enrollment in the EPN program is an effort to promote driver safety, and that my driver license report will be released to the school to determine my eligibility as a volunteer driver. I waive, release and discharge Chartwell School, its trustees, officers and employees from any claims, demands, costs, causes of action, damages as a result of property loss or damage, or personal injuries sustained to myself and to passengers of a vehicle that I am driving during participation in or travelling to and from locations of any school activity. Furthermore, I intend this waiver and release to be legally binding on my heirs, executors, administrators, estate and assigns. I agree to notify Chartwell School in writing if there is a change in the status of my driver license or vehicle liability insurance. CA Driver License #: _____________________________ License Type: ______________ ______________________________________________ __________________________ Parent / Guardian Signature Date _____________________________________________________________________________________
School Administrative Authorization _____ Copy of Driver’s License received _____ Copy of Proof of Insurance received ______________________________________________ ________________________________ Chartwell School Representative Date
Counseling Services Consent Form
Student’s Name: ______________________________________________________________________
Counseling services are available for your Chartwell student at no cost to families. Carolyn Kelleher, M.A., LMFT, a licensed Marriage & Family Therapist, provides services for our students and families. Working from a developmental perspective, she helps students learn how to manage social situations by teaching them skills to navigate the various social roles they encounter. Ms. Kelleher has been licensed for 20 years, spending the majority of her career working with students diagnosed with learning differences. Counseling sessions are a place where your child can discuss thoughts and feelings, improve relationships and self-‐esteem, resolve conflicts, and learn coping techniques. Services may be provided in an individual or group setting. Our intention is that children receiving counseling services know they are in a safe and confidential environment where they may freely discuss their thoughts and feelings. Chartwell School staff works as a team to provide the best experience for your child; therefore, by giving permission for your child to receive counseling services, you also give permission for Chartwell School staff members to consult with each other regarding your child. Ms. Kelleher may need to review your child’s cumulative records and medical history. Information disclosed within sessions is confidential and will not be revealed by the counselor or staff without your written permission with the following exceptions as mandated by law: If there is a suspicion that a child may harm him/herself, someone else or someone else’s property, or if there is a suspicion that a child is being physically, sexually or emotionally abused. If more intensive professional intervention is necessary, Ms. Kelleher will inform you and assist you in this process. If you have questions regarding these services, contact Carolyn Kelleher at (831) 394-‐3468, extension 2090. I have read and understand these conditions, and I give permission for my child to receive counseling services. ______________________________________________ ________________________________ Parent / Guardian Signature Date ______________________________________________ ________________________________ Preferred Time to Contact Parent / Guardian Preferred Phone Number to Call
CHARTWELL SCHOOL
Field Experience Release & Waiver of Liability Agreement
Student’s Name: ______________________________________________________________________ I hereby acknowledge and authorize my child to participate in any and all educational field experiences (day and overnight) sponsored and administered by Chartwell School. I understand that field experiences (day and overnight) may involve an inherent risk of and exposure to property damage and bodily or personal injury to my child or to others. I acknowledge and agree that there are risks, hazards, and dangers inherent in field experiences, including risks associated with preparation for, and travel to and from field trips. I understand and agree that the Board of Trustees of Chartwell School, its individual members, and its officers, agents, and employees, hereinafter referred to as “Releasee”, do not warrant or guarantee in any respect the competency or mental or physical condition of any third-‐party affiliated with any and all field experiences, including third-‐party teachers, leaders, instructors, volunteers, vehicle drivers, or individual participants in any field experience; that Releasee makes no warranty as to the condition, safety, or suitability of any equipment, vehicle, property, or premises for any purpose if not owned by Releasee; and that I am solely responsible, through insurance or otherwise, for any hospital or other costs arising out of any bodily injury or property damage sustained to my child during participation in any and all field experiences. For the sole consideration of Releasee arranging for and allowing my child’s participation in the field experience, I hereby waive liability, release, hold harmless, covenant not to sue, and forever discharge Releasee from any and all liability, claims, demands, rights, and causes of action of any kind, arising from or by reason of any personal injury, property damage, or the consequences thereof, whether caused by the negligence or carelessness of the Releasee or otherwise, resulting from or in any way connected with my child’s participation in a field experience. I understand and agree that Releasee may not have medical personnel available at the locations of any and all field experiences; that Releasee is granted permission to authorize emergency medical treatment for my child; that such action by Releasee shall be subject to the terms of this Agreement; and that Releasee assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. I understand that my signature indicates acceptance of this Release and Waiver of Liability Agreement which shall be effective during my child’s participation in any and all field experiences while enrolled at Chartwell (unless parents advise otherwise in writing); that it binds me and my heirs, executors, administrators, and assigns; and that if any of its terms or provisions are held unenforceable, or in conflict with any law, the validity of the remaining portions shall not be thereby affected. I have read, understand, and have freely and voluntarily signed this Release and Waiver of Liability Agreement. I warrant that I am the parental guardian of the child mentioned above. ________________________________________ ________________________________ Parent / Guardian Signature Date
CHARTWELL SCHOOL
After-School Homework
Program Agreement
Student’s Name: _________________________________________ Homework Fee – $15 per hour
Day & Time Enrolled in After-School Homework Program (please check all that apply)
Monday (3 – 4 PM) Tuesday (3 – 4 PM) Wednesday (3 – 4 PM) Thursday (3 – 4 PM)
Monday (4 – 5 PM) Tuesday (4 – 5 PM) Wednesday (4 – 5 PM) Thursday (4 – 5 PM)
In return for enrolling the student named above (the “Student”) in Chartwell School’s After-School Homework
Program (“Program”), each of the undersigned agrees, as follows:
1. Fee. I agree to pay Chartwell School the hourly homework fee of $15 billed to the Student’s Smart
Tuition account. The per-hour rate is the minimum fee charged. For late pickups, parents will be charged an
additional fee of $15 to their Smart Tuition account.
2. No Refund. I understand that the overhead expenses of Chartwell School do not diminish should the
Student depart during the course of the above identified Program(s) and that my obligation to pay the tuition is
final and unconditional. I further understand that no portion of the Student’s tuition will be refunded and my
obligation to pay the tuition will not be canceled, notwithstanding the absence, withdrawal, dismissal or
disenrollment of the student from Chartwell School.
3. Rules and Regulations. I agree to accept the rules, regulations and policies of Chartwell School. The
School requires that its students, faculty and administrators follow the rules and regulations of the School. The
School also expects parents to recognize and follow the rules and regulations of the School. Courtesy and civility
are part of this, especially when it relates to dealings between parents and the School administrators, or
representatives of the school, such as the teaching staff. Parents are subject to the rules, regulations and
policies of the School, in that they have a contractual relationship with the school, but most importantly they
also set an example to our students. Therefore, Chartwell School places great emphasis on comportment of all
the members of the school community including parents and families.
4. Damages. I agree to be responsible for all damages to Chartwell School or other private property
caused by the Student.
5. Personal Effects. I understand that the Student’s personal effects are his or her sole responsibility and
that Chartwell School will not be responsible for loss of or damage to these effects.
6. Learning Disabilities. I understand that Chartwell makes neither warranty nor guarantee that it will
achieve success with every student and that attendance at Chartwell will not result in the cure or elimination of
dyslexia or any other learning disability being experienced by the Student.
CHARTWELL SCHOOL
After-School Homework Program
Page 2
7. Removal of Students. Chartwell School reserves the right to remove a student at any time if, in the
judgement of the Head of School, the Student’s industry, progress, conduct or influence on or off campus is not
in keeping with Chartwell School’s accepted standards. In such case, there will be no refund of tuition, and any
unpaid balance will be payable in full according to the tuition payment plan.
8. This Agreement shall be construed under the laws of the State of California.
9. This Agreement can only be modified in writing with full consent and agreement of Chartwell School.
10. Should a court of competent jurisdiction find any provision of the Agreement unenforceable, the
remaining provisions shall continue in full force and effect.
Chartwell School seeks to the best of its ability to respond to the special education needs of enrolled students.
A complete, independent interpretation of these needs includes Chartwell staff reviewing all records related to
these needs as other professionals have observed them over the course of the child’s developmental history.
If your child has experienced either organically or emotionally based problems, which have necessitated the use
of medication or therapeutic intervention, it is of the utmost importance that this be indicated and described at
the time of application. This information will allow us to address your child’s needs more effectively.
Withholding such information can only jeopardize your child’s well being and deter from the school’s ability to
handle any problems that may arise.
If it is determined that such critical information including, but not limited to any psycho-educational, sensory-
perceptual, psychiatric, counseling, diagnostic or academic assessments, has been either intentionally or
inadvertently withheld, Chartwell School reserves the right to withdraw a student’s acceptance or terminate
placement. Parents’ signature authorizes Chartwell School to contact educators representing prior educational
placement and professionals responsible any of the above referenced for evaluations.
This Enrollment Agreement must be signed by either parent of the Student or by any other individual accepting
responsibility for payment of tuition for the Student. In case of delinquency in the payment of tuition, Chartwell
School will endeavor to look first for payment to the individual assuming primary financial responsibility, but all
signatories to this Agreement accept liability for payment of tuition. This agreement is effective upon
acceptance by Chartwell School. No Student shall be allowed to attend classes until this document is signed and
returned to Chartwell School.
Please call 831-394-3468 x 2010 if your child won’t be attending the homework program on your scheduled day.
Parent Authorization
Parent / Guardian Signature: ________________________________________ Date: _______________________
School Authorization
Head of School Signature: ________________________________________ Date: _______________________
