PROVIDER/PARENT-GUARDIAN CHILD CARE CONTRACT
DATE___________________
The following agreement is made between:
PROVIDER
Lisa Miller
316 Grandeur Lane
Box Elder, SD 57719
(605)791-0669
AND
______________________________________ ___________________ ___________________
Father/Legal Guardian Home Phone Work Phone
Home Address
Rank, Squadron, Employer’s Name and Address
__________________________________ ___________________________
Social Security Cell Phone
AND
______________________________________ ___________________ ___________________
Mother/Legal Guardian Home Phone Work Phone
_____________________________________________________________________________
Home Address
_____________________________________________________________________________
Rank, Squadron, Employer’s Name and Address
__________________________________ ___________________________
Social Security Cell Phone
[ ]Married [ ]Divorced [ ]Single [ ]Separated [ ]Widowed
For the care of:
_______________________________________ _____________________________
Child’s Name Date of Birth
Sex [ ]Female [ ]Male
_______________________________________ _____________________________
Child’s Name Date of Birth
Sex [ ]Female [ ]Male
Each child being cared for in Little ABC Monkeys Daycare home must have an emergency contact other than parent. You are required to have 2 and must be a responsible Adult to notify in your absence.
_______________________________________ _____________________________
Name Phone Number
_______________________________________ _____________________________
Name Phone Number
Provider may contact the individuals above to ensure that they are aware that you have listed them as your emergency contact. Please inform the individuals that they will be contacted in the event that an emergency arises such as an illness and I am not able to contact you the parent/guardian and that they will be expected to pick the child up in a timely manner.
Person(s) designed to pick up child(ren) other than parents, emergency contact and they must be over the age of 14:
_______________________________________ _____________________________
Name Phone Number
_______________________________________ _____________________________
Name Phone Number
Child(ren) will not be released to anyone other than parent/guardian(s) or those listed above without written authorization from parent/guardian. Person(s) must show picture identification prior to release of child(ren).
BASIC RATES AND PAYMENT POLICIES:
A 2 week deposit is required and will go towards your child(ren) first 2 weeks of care. The 2 week deposit is nonrefundable.
INT._____
There are a few months that have 5 weeks in them, when this occurs you have the option to either pay for 3 weeks or for 2.5 weeks over 2 paydays.
INT._______________
If you are on state assistant you are responsible to pay the difference of what the state doesn’t pay.
INT._______________
The payment fee will be every Friday, every other Friday or on military paydays.
INT._______________
Child Care begins at Ends at
Monday ___________________ _________________________
Tuesday ___________________ _________________________
Wednesday _________________ _________________________
Thursday __________________ _________________________
Friday ____________________ _________________________
Saturday __________________ _________________________
Sunday _____________________ _________________________
I need to know if your schedule has changed as soon as you know and a new schedule form needs to be completed and signed.
INT._______________
Payment will be due [ ]every Friday [ ]every other Friday [ ]military paydays
INT._______________
If you fail to pay me on your scheduled payday by 5:30 P.M., you will be charged $25.00 a day for each day you are late paying and your child will not be accepted to daycare until the bill is paid.
INT._______________
OVERTIME RATES:
If your child will not be coming to daycare or will be late arriving, I need to be notified as soon as possible but no later than 9:00 A.M. of that day. So that I can plan accordingly, it is important to understand that late arrival does not justify late departure.
INT._______________
I must be notified no later than _________________ AM/PM if you are planning on being late in picking up your child. Late fees will be imposed if I am not notified within 30 minutes of pick-up time. If you do not notify me late fees will be $5.00 per child for each 30 minutes you are late, payable on your next payday. If you have not picked up your child an hour after your scheduled pick-up time, then I will be calling your emergency contacts to pick your child up.
INT._______________________
BY SIGNING THIS CONTRACT ALL PARTIES AGREE TO THE TERMS STATED IN THIS CONTRACT. PROVIDING FALSE INFORMATION COULD RESULT IN TERMINATION OF DAYCARE. PARENT(S)/LEGAL GUARDIAN(S) ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND AGREE TO ABIDE BY IT, AS WELL AS THE PARENT HANDBOOK. THE CONTRACT MAY BE CHANGED BY THE PROVIDER WITH A TWO WEEK WRITTEN NOTICE TO THE PARENT(S)/GUARDIAN(S). THE PARENT(S)/GUARDIAN(S) WILL BE GIVEN A COPY OF THE CHANGES BEFORE THEY ARE PUT INTO EFFECT.
