BEECH STREET SCHOOL MORNING CLUBS FOR MORE INFORMATION CONTACT MORNING READING (All Grades): Come join us as we explore a new story every morning Norma Gonzalez from 7:40 to 8:10 A.M.! All grades welcome! AFTERNOON CLUBS Site Coordinator BRAIN BOOSTERS! (Project iSucceed) (Gr. 3): Listen to a story, read a book, or get help 603-591-4078 with your school work. [email protected] POWER HOUR! (Project iSucceed) (Gr. 4-5): Students will have an opportunity to work on school work. PLAYDOUGH TIME! (Gr. K): Create fun and moldable animals, letters, and other neat stuff THE SCHEDULE using playdough! STORY & CRAFT (Gr. 1- 2): Come listen to Ms. Newman read a new story every week and then you can create a new and interesting art project to go along with it! Please choose the 7:302:45 3:15 - 4:15 4:15 - 5:15 appropriate day! BOOK BUDDIES (Project iSucceed) (Gr. 2): Find and read some great books with Ms. Hendrickson. After reading them, you can share the ones you like with your book buddies. M S BRAIN BOOSTERS 3 READING EGGS (Gr. 1-2): This is a fun web-based reading program for students interested DODGEBALL 1-2 in improving reading skills. O Morning N POWER HOUR 4-5 DODGEBALL GAMES (Gr. 1-2): Learn how to play different dodgeball games in a safe, fun A ONLINE COMICS 4-5 way with Ms. Newman. N Reading PLAY DOUGH TIME K C ONLINE COMICS (Gr. 4-5): Join Mrs. Hannemann and Ms. DiFloures and construct some MATH BUILD UP! 3 funny comics using BitStrips, a cartoon and comic creation website. K (All) STORY & CRAFT 1 MATH BUILD UP! (Project iSucceed) (Gr. 3): Be the strongest math brain in your class! Join us to get good and quick at math! TREEHOUSE 3-5 BOOK BUDDIES 2 MAGIC TREE HOUSE (Project iSucceed) (Gr. 3-5): Explore the wonderful Magic Tree House book series with Ms. Hendrickson. THEATRE 2-3 READING EGGS 1-2 READER’S THEATRE (Gr. 2-3): Join us for a whole lot of fun by doing a little acting and a little writing. This club is a two day a week commitment. T S BRAIN BOOSTERS 3 STAMP IT UP! 4-5 DUPLO & LEGO BRICKS (Gr. K & 3-5): If you want to invent, tinker with, and assemble U Morning N amazing contraptions, this is the place to be! Chose appropriate club and times! POWER HOUR 4-5 PAINT CLUB (Gr. 1-2): Learn to paint some cute creations with Ms. Shea. ORIGAMI 3 E A SEWING CIRCLE (Gr. 4-5): Have you ever wanted to learn how to sew by hand? This is your Reading DUPLO BRICKS K C chance! Each student will make a project to take home. COOL MATH 3-5 K CHORUS (Gr. 3-5): We will work on technique, breathing, and ensemble skills while having (All) PAINTING 1-2 fun! This is a year long commitment. THEATRE 2-3 STAMP IT UP! (Gr. 4-5): Join Mrs. Hannemann in creating some spiffy creations relating to SEWING CIRCLE 4-5 your favorite authors, holidays, and special occasions. UNO CLUB 3-4 ORIGAMI (Gr. 3-5): Learn the ancient art of paper folding with Ms. Schuff. CHORUS 3-5 COOL MATH GAMES (Gr. 3-5): Come hone your skills in math, geography, and other awesome subjects by using the school’s computers and playing on the “Cool Math Games” webW S LEGO BRICKS 3-5 BRAIN BOOSTERS 3 site. E N UNO CLUB (Gr. 3-4): Learn how to play Uno and have fun with your friends. Bring your good Morning MATH BUILD UP 3 POWER HOUR 4-5 D A attitude because being a good sport is key to having fun. LEARN TO DRAW (Gr. 1-2): Join Ms. Shea and learn how to draw animals, cartoon characReading READING EGGS K BEADING 3-5 C ters, and other fun stuff! K (All) LEARN TO DRAW 1-2 STUART LITTLE (Project iSucceed) (Gr. 3-5): Join us as we read about a little mouse with a POETRY JAM 3 big heart. Learn how he finds adventure and a loving home in the most unexpected place. We STUART LITTLE 3-5 STARFISH CORPS 3-5 will complete our journey with the movie and popcorn! BEADING CLUB (Gr. 3-5): Make your own bracelets using a small beading loom. Past attendance will account for your acceptance to this club. BRAIN BOOSTERS 3 T S FUNDRAISING 4-5 POETRY JAM (Gr. 3): Do you have the time to sing and rhyme? Join us as we recite some H Morning N POWER HOUR 4-5 MATH BUILD UP! 3 funny poems that will have us singing and giggling! A STARFISH (Gr. 3-5): In City Year’s Starfish Corps participants make friends, read aloud, sing, U Reading BOARD GAMES K COMIC BOOK 3-5 create arts and crafts, meet interesting role models from the community, and participate in C hands-on projects. K (All) STORY & CRAFT 2 ORIGAMI 4-5 BOARD GAMES (Gr. K): Have fun and make new friends while you play games like Candy Land, Cooties, and Chutes and Ladders. LOVE AMERICA! 3-5 BASKETBALL PREP 3 LOVE AMERICA! (Project iSucceed) (Gr. 3-5): We will read, draw maps, and color projects centered around famous American moments in history. F S TAP DANCE 1-2 FUNRAISING CLUB (Gr. 4-5): Put your creativity to good use! Help us raise money for local TAP DANCE 3-5 school projects or charity. Students will choose a project or charity to give to. R Morning N 3-D ART 1-2 ONLINE COMICS 3-5 COMIC BOOK CLUB (Gr. 3-5): Create and show off your own comic book characters to your I A friends by creating stories for them! Reading COOL MATH 3-5 READING EGGS K-1 C BASKETBALL PREP (Gr. 3): Hey third graders! Get ready for next year’s basketball team by joining Ms. Newman and honing your skills. K (All) POKEMON 4-5 TAP DANCE (Gr. 1-5): Our community partner, Bedford Youth Performing Company, is back! Come learn an exciting form of dancing and tap your way to a good time! * Project iSucceed is funded in part by Manchester’s Community ImPOKEMON CLUB (Gr. 4-5): Students are invited to join Mr. Lewin to play the Pokemon card provement Program (CIP) Funds. game. Bring your Pokemon cards to play with your friends. (This is a student requested club.) 3-D ART (Gr. 1-5): Use a variety of intriguing materials to create new and interesting art in 3THANKS TO OUR PROGRAM TEACHERS, D. PARTNERS & PROVIDERS!

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Yes I would like to make a donation to the 21st CCLC program. Please make out checks out the Manchester School

RELEASE: As the parent/guardian, signing this form, I acknowledge, understand and agree with the 21st CCLC program procedures, policies and expectations including the following: I understand that nursing services are not provided during the afterschool program. I agree to notify the site coordinator of all medical conditions/needs related to my son/daughter. Initials: _______ I authorize the 21stCCLC program staff to take the appropriate action to protect the well-being and safety of my son/daughter including seeking emergency medical attention or hospitalization (or both) should the need arise and I am unable to be reached. Initials: _______ I give permission to the 21st CCLC staff to photograph or video graph my son/daughter for use on the school website or in promotional material (or both) for the program. Yes □ No □ Initials: _______ I authorize the release of my free/reduced school lunch status to the site coordinator. Yes □ No □ Initials: _______ I agree to hold harmless and indemnify SAU #37 and its districts, officers, agents, employees, volunteers and contractors from all claims, demands, causes of action that arise from any unintentional or claimed negligent act or omission resulting from any student’s participation in the 21st CCLC program. _______________________________________________________________________ Signature Parent/Guardian Date

HOW TO PARTICIPATE 1. Choose the desired classes with your son/daughter. Sign up for as many classes as you wish. Classes are on a first-come, first-need basis and may be cancelled due to low enrollment. Circle your choices on the course schedule (on back) and keep for your records.

2. Complete both sides of the registration form below. A separate registration form is required for each student. Incomplete forms will delay registration and greatly lower your chances of getting into a club.

3. Return the registration form to the main office of your school. 4.

If are donating, please make checks payable to the Manchester School District. A $30 fee will be assessed for checks returned due to insufficient funds.

COST There is no cost to attend these clubs. We do ask that students make the commitment of coming to each and every club they get accepted into.

If you’d like to make a donation to the 21st CCLC program, please include amount on the course selection form. Thank you for your support!

THE FINE PRINT The 21st CCLC wants your son’s/daughter’s after-school experience to be a positive one. Our goal is to provide a fun and safe learning environment for all participants. Please review the following information with your son or daughter. BEHAVIOR STANDARDS - Students participating in the program are held to the Manchester School District’s Behavior Standards. Repeated disruptions or disrespect for others and/or for their property may result in removal from the program. DISMISSAL - Students will be dismissed as indicated on your registration form. You must notify the site coordinator in advance if you are unable to pick up your student as designated. Failure to do so will result in a maximum waiting period of thirty minutes. If we are unable to contact you during that time, we may contact local authorities. ABSENCE FROM PROGRAM - Time does not allow for parents to be contacted when students are absent from the 21st CCLC program. CANCELLATION - The program does not operate on holidays, school vacation periods or early release days and will be cancelled when schools close due to inclement weather or unforeseen events. Notification will be made through the school’s standard procedure.

Student Name ______________________________________ Date of Birth _____________Grade Level _________ Teacher_____________________________ Home Phone __________________________ Street Address _______________________________________________________________________________ Mother’s Name ______________________________________Day Phone ___________________Cell # __________________Email ______________________ Father’s Name ______________________________________ Day Phone ___________________Cell # __________________Email ______________________ EMERGENCY CONTACTS (Other than parents) Name: ___________________________________________ Phone ___________________________________ Relationship ____________________________ Name: ___________________________________________ Phone ___________________________________ Relationship ____________________________ My son/daughter has my permission to be dismissed from the 21st CCLC program as follows: □ Walk home at 4:15 p.m. (There are no crossing guards are not available.) *STUDENTS WITH A 5:15 P.M. DISMISSAL MUST BE PICKED UP BY A PARENT OR OLDER SIBLING.*

□ Be picked up by __________________________________________________________________________________________ □ Go to the Y-Start (Please note that Y-Start students can only be enrolled in two 21C clubs per school year.) □ List all relatives enrolled in program ___________________________________________________________________________

REGISTRATION FORMS ARE DUE TO BEECH STREET SCHOOL BY , WEDNESDAY, NOVEMBER 6, 2013 PLEASE COMPLETE BOTH SIDES. INCOMPLETE FORMS MAY AFFECT YOUR CHANCES OF GETTING INTO A CLUB. NUMBER OF FAMILY MEMBERS IN HOUSEHOLD

HEAD OF HOUSEHOLD (Please circle one)

MOTHER

FATHER