Child Care Agreement

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CHILD
CHILD
CARE
CARE
AGREEMENT
AGREEMENT
CHILD
CHILD CARE
CARE AGREEMENT
AGREEMENT
- The following agreement is being entered into by:
____________________________________and___________________________________________
(Parents/Guardians)
(Provider)
For the care of ________________________________________________________________________
(Name of Child or Children)
Care will be provided for the following days and times:
S
M
T
W
TH
F
S
(Circle those that apply)
Hours:
From _______________to___________________
Payment of_____________________ is to be paid_____________________________________
Please submit completed:
1.
Emergency Form
3. Health Inventory
2.
Current Immunizations Record
4. Parent's Guide to Regulated Child Care Receipt or
obtain
@ (divisions/child care/licensing branch/parent guide.html
Exclusion for Acute illness
Children will be excluded from care if they exhibit any of the following symptoms:
) Fever
2) Vomiting
3) Diarrhea
4) Seizure
5) Severe Pain
6) Rash
Children who have a serious transmissible or communicable disease will also be excluded during the
period of exclusion for that infection or disease.
Provision of Food — Provider will supply healthy snacks and beverages that comply with guidelines of the
Child & Adult Care Food Program.
The following will be furnished by the provider (Circle all that apply)
Breakfast
Lunch
Dinner
Regulations require that there be no more than a 3-hour interval between meals and snacks. Parents
are to provide any required meals not circled above and any infant foods. Foods brought from home
should be nutritious and in amounts appropriate for the child's age.
Permission to Transport
has permission to transport my child/children to:

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