Hours of Operation:
Full-time day positions are Monday thru Friday
from ___6:30___a.m. till _5:30_____p.m.
You must be here to pick up your child no later then __5:30_____.
Full time is considered ____30 or more hours__________________________. Full-time is not to exceed 10 hours a day. If this happens you will be charged $___5.00_____ every 10 minutes until you arrive to pick up your child. All late fees are paid on the day that they are accrued.
Attendance and Fees:

Payday is every __Monday______ morning before you drop off your child. The fee is non-refundable even if your child misses a day or more. You must pay for the entire week whether your child is here or not.
Not to be harsh, but Daycare fees should be one of your most important bills to pay since without it you may not be able to work so please do not ask me if you can pay the following week because of another bill. This can become a bad habit to get into so I do not allow it.

The daycare fee is subject to change yearly. I will give you ___2 weeks____ notice of any changes.

Payment Agreement:
Parent(s) or Guardian(s) agree to pay the sum of $________per week for the care of their child/children. THIS FEE IS DUE REGARDLESS IF CHILD MISSES ANY DAYS THAT WEEK. Payment is to be made every ___week__. If 1 consecutive pay periods are missed, this contract will automatically be terminated. A penalty fee of $___10__ per day will be charged for each day that you are late paying your account.

Failure to pay the past due amount will result in legal action being taken against you. This includes your normal weekly rate or any overtime or late fees that you may have accrued. Parents or Guardians must pay the 2 week fee for ending child care services. This is a cash only basis.

You must return all forms filled out completely before your child/children
enters my care. All forms and contracts are subject to renewal every year and must be kept up to date.

You are required to supply:

*A Copy of Immunization Records. (these must be kept updated)
*Medication administration Authorization.
*A Doctors Statement if the child Needs to Wear Cloth Diapers.
Otherwise, Disposable Diapers Only or pullups if potty training.

*Please fill out the information as accurately as possible;

Name of parent(s) or Guardian(s): _______________________________________________
Address: _______________________________Home Phone: _________________________
Place of Employment: _____________________Work Phone: _________________________
Name of Child/Children: _________________________Ages: ________________________
Date of Birth(s): _____________________________________________________________
Name of Doctor: ________________Address

Phone: ______________________________
Child/Children’s Allergies: _____________________________________________________
Emergency contact if Parents or guardians cannot be reached: ________________________
Emergency Contact Phone Number: ___________

Relationship to Child: ________________
Persons Authorized to Pick up Child/Children:


Drop off Time:
You must call at least __30_ minutes in advance of your normal drop off time if your child/children will not be coming on any given day. This helps me to plan our daily activities.

Your Child’s Safety:
Please have your child/children dressed and ready for play upon arrival. Please do not send your child/children barefoot. Even on hot days , shoes are needed for health and safety reasons.

First Aid:
Scratches and scrapes will be treated with soap and water and a Band-Aid. (if needed) You will be notified immediately for anything more serious. For major emergencies which require the services of an emergency medical team, the child will be transported by ambulance. For minor emergencies , you will be notified and you will transport the child if medical treatment is needed. If circumstances warrant, and you cannot be reached, I will get in touch with your emergency contact.
Discipline and Behavior:
Your child/children will be disciplined in a manner appropriate to the situation. This discipline is not abusive and does NOT include corporal punishment. (usual discipline consists of redirection and cooling down periods.) If needed we will have a conference to discuss behavioral problems and ways to solve them. Acceptable behavior is encouraged by giving positive verbal rewards.

Personal Belongings and Clothing:
Please send your child/children with an extra change of clothes incase of an accident. Children should wear play clothes and dress according to the weather. If your child/children is dressed inappropriately he/she may miss out on some outdoor activities.

Parents Signature……………………………………………………………………
Provider’s Signature……………………………………………………