Name of Child
I AGREE TO UPDATE MY CHILD’S FILE AS NEEDED AND ALSO WHEN ADMINISTRATION REQUIRES IT. UPDATES MUST INCLUDE YOUR JOB INFORMATION, SCHOOL INFORMATION, PHONE, ADDRESS, OR WHEN DESIGNATED RELEASE TO PERSONS CHANGE. I UNDERSTAND THAT EMERGENCY CONTACTS NEED UPDATING A MINIMUM OF EVERY SIX MONTHS OR AS NEEDED. I ALSO AGREE TO UPDATE MY CHILD’S HEALTH RECORDS INCLUDING SHOT UPDATES AS STATED IN THE HANDBOOK.
EXTRA FEES:
IF TRANSPORTATION IS PROVIDED THE FEE IS $10.00 WEEKLY PRIOR TO SERVICE. IF MY CHILD IS OVER THEIR SCHEDULED TIME A FEE OF $1.00 PER MINUTE PER CHILD WILL BE ASSESSED AFTER THE FIRST 5 MINUTES. THIS FEE MUST BE PAID PRIOR TO THE NEXT DAY OF CARE OR ARRANGEMENTS MUST BE MADE WITH THE ADMINISTRATION. IF YOUR CHILD IS OUT OF DIAPERS, THEY ARE $1.00 EACH AND A PACK OF WIPES ARE $5.00 AS WELL AS UNRETURNED SPARE CLOTHES.
Parent Signature
Enrollment Date
Restart Date
Withdrawal Date