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Extended Day Care & Middle School Childcare Service Agreement Form - Parma City School District

9/22/2014

1.1

PARMA CITY SCHOOL DISTRICT

EXTENDED DAY CARE & MIDDLE SCHOOL CHILDCARE

SERVICE AGREEMENT

I request that _____________________________________________ who is in Grade ________, and attends

Child’s Full Name

EDC at _________________________________ on the following days:

School child attends EDC

BEFORE SCHOOL PROGRAM

_____M,

_____T,

_____W,

_____Th,

_____F

AFTER SCHOOL PROGRAM

_____M,

_____T,

_____W,

_____Th,

_____F

The first day my child will attend the childcare program will be on _________________ (date required). This

Service Agreement becomes effective on that date. (Returning children are charged from the first day of

school.) My child will arrive at or about ________ AM and will depart at or about _______ PM. The last day of

service will be the last student school day. Withdrawal from the program before the last day will result in loss of

reserved space for following school year. Tuition is payable through and including the last day care is provided in

June, 2015.

I have received and agree to read the Extended Day Care/Middle School Childcare Parent

Handbook and abide by all the policies established by the childcare program including the

policy that tuition is charged for snow/calamity days.

I understand that if the program determines that I am not fulfilling my obligations under this agreement my child

could be immediately withdrawn from the program. If my child is withdrawn from the program, I understand it is

my responsibility to seek alternative childcare arrangements and to pay all fees accumulated.

I understand that if changes in days or times become necessary, a new service agreement must be signed.

_________________________________________________________

_________________________________________________________________

Signature of EDC/MS Representative

Signature of Parent/Guardian responsible for payment

________________________________________________________________

Date

Parents using a swipe card to record time and attendance must also

complete Service Agreement Page 2 on reverse

Extended Day Care & Middle School Childcare Service Agreement Form - Parma City School District