Child Care Agreement (Page 2 of 2) in pdf

Child Care Agreement Page 2

(Outings which occur on a regular basis)

A separate permission form will be required for all other field trips.

Appropriate safety seats and seat belts will be used at all times for transporting.

Medication

Medication (nonprescription or prescription) will not be administered without written parental and

health practitioner permission on the Medication Authorization form. The provider is not to administer

the first dose of any medication. There must also be parental written permission for application of over

the counter preventative treatments including: diaper ointments, insect repellants, and sunscreens.

Discipline Policy

Procedures for discipline will not include the deliberate infliction in any manner of any type of physical

pain or emotional harm. To guide children's behavior I plan to:

Pet Policy

No Pets

Pets

Pets Allowed

Allowed

The following pets reside here:

Screen Time Policy — Younger than 2 years old may not be permitted to view any passive technology

and 2 years old and older may not view more than 30 minutes of age-appropriate educational passive

technology per week. No passive or interactive technology shall be viewed during meal or snack.

Therefore I will:

Volunteers (if applicable):_____________________________________________________________

if overnight care, the approved sleeping arrangements are:

Termination of Care

Any violation of this agreement may be just cause for termination of care. Any other termination of care

requires a two-week notice by either party.

_____________________________________

___________________________________

Provider Signature

Date

Parent Signature

Date

Revised 08/14/15

Child Care Agreement Page 2