Director Signature. Director Full Name (print) ...................................................................................................... *Director/*Secretary Signature ...................................................................................................... *Director/*Secretary Full Name (print) (* please strike out inapplicable *if Sole Director/Secretary write ‘Sole’)
Director Signature. I acknowledge that I have read and reviewed a copy of the Plan’s prospectus. If the Company determines that it is required to withhold any taxes, including, but not limited to, income or employment taxes, prior to the date of payout, I agree that the Company will satisfy such taxes by withholding from the shares otherwise issuable to me as described in my grant agreement. I also understand that, upon receipt of payout, in addition to federal taxes, I may owe taxes both (1) to the state where I resided on the Date of Grant or at the time of making this election and, if different, (2) to the state where I reside when I receive payout.
Director Signature. Director name Date ............................................................................ Director/Company Secretary signature ............................................................................ Director/Company Secretary name Date
Director Signature. Date: Termination of this agreement occurs when a child leaves the program and all fees have been paid. Parents may withdraw the child for any reason. The Center may terminate this agreement if the program does not meet the needs of the child. Rev. 10/2023
Director Signature. I acknowledge that I have read and reviewed a copy of the Plan’s prospectus. I understand that my decision to defer the settlement of Stock Units will make me only a general, unsecured creditor of the Company. I also understand that the amounts deferred will be taxable as ordinary income in the year paid. If the Company determines that it is required to withhold for any taxes, including, but not limited to, income or employment taxes, prior to the date of deferred payout, I agree that, if I do not make other arrangements that are satisfactory to the Committee, in its sole discretion, the Company will withhold from the amounts due to me. I also understand that, upon receipt of deferred payouts, in addition to federal taxes, I may owe taxes both (1) to the state where I resided at the time of making this election and, if different, (2) to the state where I reside when I receive a deferred payout.
Director Signature. Director Name (BLOCK CAPITALS)
Director Signature. Director full name (BLOCK LETTERS) ) ) ) ) ) ) ) ) ) ) ) ) ............................................................... Director/Secretary signature ............................................................... Director/Secretary full name (BLOCK LETTERS)
Director Signature. I acknowledge that I have read and reviewed a copy of the Plan’s prospectus. I understand that my decision to defer the settlement of Stock Units will make me only a general, unsecured creditor of the Company. I also understand that the amounts deferred will be taxable as ordinary income in the year paid. If the Company determines that it is required to withhold for any taxes, including, but not limited to, income or employment taxes, prior to the date of deferred payout, I agree that, if I do not make other arrangements that are satisfactory to the Committee, in its sole discretion, the Company will withhold from the amounts due to me. I also understand that, upon receipt of deferred payouts, in addition to federal taxes, I may owe taxes both (1) to the state where I resided at the time of making this election and, if different, (2) to the state where I reside when I receive a deferred payout. The Committee shall have the discretion to make all determinations and decisions regarding this deferral election. To the extent the Committee determines that this election does not comply with applicable laws, now or in the future, this election shall be null and void. In such an event, amounts deferred shall be settled (1) immediately if the Original Payment Date already has occurred, or (2) upon the Original Payment Date if in the future. By signing this Election Form, I authorize implementation of the above instructions. I understand that the deferral elections that I have made on this Election Form are generally irrevocable and may not be changed in the future except in accordance with the requirements of Section 409A and the procedures specified by the Committee. DIRECTOR
Director Signature. In the presence of ) ---------------------------------------------- SIGNED on behalf of the ) Professionals Association ) ) ………………………………………….
Director Signature. Date: Termination of this agreement occurs when a child leaves the program and all fees have been paid. Parents may withdraw the child for any reason. The Center may terminate this agreement if the program does not meet the needs of the child. ***************** Rev. 3/2022 Registration $35 when returning forms before 4/30/22; $40 thereafter. When you fill out your Summer admission agreement you have the option of a Contract agreement or a Flex agreement. • Your child can come on random days, as you need and you only pay for days attended. • If your child will be away from the HCLCC more than 2 weeks during the summer this is the most economical choice for you. (This rarely happens in the summer.) •Flex schedules will be billed at the end of the month. Contract Agreement: • Better deal if your child will attend a set schedule throughout the summer. • The contract reserves your child’s space and you pay for that schedule whether or not the child attends. • You can request up to two weeks of vacation credit during the summer. • Billing is done at the beginning of each month. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Split Charges (when parents/guardians want to be billed separately): We, the parents/guardians of , wish to be charged separately for Child(xxx)'s Name(s) tuition costs as stated below: Parent Signature Date Parent Signature Date
