Form Ogc-S-2000-03 - Children'S Learning Centers Enrollment Agreement Page 2
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3Form No. OGC-S-2000-03
time can result in late fees of, $25.00 for the first five (5) minutes, an additional $20.00 for the
next five (5) minutes and $1.00 for each additional minute after 6:10 p.m. Repeated failure to
pick up your child up on time may result in probationary enrollment and/or termination of
services.
Agreement Renewal: In order to renew your enrollment agreement with Centers you must
______ (initial)
submit a new agreement and pay all fees at least two (2) weeks before this Agreement expires. If
this Agreement expires, without being renewed, enrollment will be terminated.
Agreement Cancellation: Cancellation of this Agreement must be requested in writing with two
______ (initial)
(2) weeks prior notice. Otherwise, this Agreement will remain in effect for twelve (12) months,
unless terminated earlier by Centers as provided herein.
Enrollment Eligibility: Only children and legal dependents of students, staff and faculty at the
______ (initial)
University of Houston are eligible for enrollment. In order for student parents to be eligible to
enroll a child at Centers, they must be enrolled for a minimum of six credit hours at UH (both in
the spring and fall semesters) and also in a degree seeking program (or in pre-requisite classes for
a degree plan) as an undergraduate/graduate student. In order for staff and faculty parents to be
eligible to enroll a child at Centers, they must be employed on a full-time basis.
Entire Agreement: This Agreement and the Children’s Learning Centers Enrollment Tuition and
______ (initial)
Annual Fee Rate Appendix contains the entire agreement between the Parties regarding the
subject matter hereof and supersedes any and all other agreements, understandings,
negotiations, or representations, whether oral or written between the Parties. No agreement shall
be effective unless it is in writing and signed by the party against whom enforcement of the
agreement is sought.
Verification of Enrollment Eligibility
: I, _________________________________________________ (parent’s name),
am a __ student __ staff __ faculty who is currently enrolled/employed at the University of Houston, and I satisfy
the enrollment eligibility requirements set forth above.
My Student ID # or Employee ID # is: __________________________________________________________________________
Department: _________________________________________________________ Work Phone: __________________________
Home Address: _______________________________________________________ Home Phone: __________________________
City: ________________________________________ Zip Code: ______________ Cell Phone: ____________________________
E-Mail Address: _______________________________________________________________________________________________
Authorized Individual(s),
other than you to contact in case of an Emergency & their local phone numbers:
1.______________________________________________________________ ______ Ph. #__________________________________
2.______________________________________________________________ ______ Ph. #__________________________________
Executed by
Enrollment Agreement Accepted by:
:
________________________________________________
__________________________________________________
Parent’s Signature
Date
Centers Director
Date
Enrollment Agreement Cancelled/Terminated
by
:
__________________________________________________
Centers Director
Date
*You are not required to provide your Social Security Number on this form so long as another form of identification number (Student
Identification Number or Driver’s License Number) is provided. However, when you pay for child care services, University policy
requires the University check writer’s Social Security Number, University extension, and Driver’s License Number appear on the
face of the check for personal check handling purposes.
Note: Modification of this Form requires approval of OGC
Office of the General Counsel
Children’s Learning Centers Enrollment Agreement
OGC-S-2000-03 Revised 06.10.11
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