Parent Provider Child Care Agreement - Satellite Family Child Care
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4This form is provided for use by Satellite – Supporting Quality in Family Child Care
Parent-Provider Child Care Agreement
Effective Date: ________________
PURPOSE
Program Name:_____________________________
The purpose of this agreement is to state the basic rights and
Program Address: ___________________________
responsibilities of the parent(s)/guardian(s) and the child
___________________________
care provider in the on-going care arrangements for the
child. This agreement is based on the premise that care of
Phone Number: _____________________________
the child is supported by clear understanding and continued
communication between the parent(s)/guardian(s) and the
child care provider.
Provider: __________________________________
This agreement to provide child care is between the child care provider identified below and the parent(s)/guardian(s)
of
, born
.
Parent(s)/Guardian(s)*
Provider
Home Address
Home Address
City
State
Zip
City
State
Zip
Telephone
Telephone
*Henceforth, “parent” will refer to parent or guardian.
In enrollment practices, the provider does not discriminate against any person, consistent with section 106.52 of the
Wisconsin Statutes or any applicable county or municipal ordinance. Currently, section 106.52 prohibits discrimination on
the basis of race, sex, color, creed, political persuasion, national origin, disability, ancestry, or sexual orientation.
A. STANDARDS OF CARE
1. The provider agrees to meet the standards of City of Madison Accreditation and to abide by the policies of
Satellite*. Parents are encouraged to review the City of Madison Accreditation Standards.
2. If the program is County Certified, the provider agrees to comply with the Certification Rules.
3. If the program is State Licensed, the provider agrees to comply with the Family Child Care Licensing Rules.
Parents will receive the pamphlet, “Your Guide to Licensed Child Care” as a summary of the Family
Child Care Licensing Rules.
4. The provider will post certificate(s) of applicable regulation, results of latest monitoring visit & current
noncompliance.
*Satellite Family Child Care is a program of Dane County Parent Council, Inc. It is funded primarily by the City of
Madison Office of Community Services. Satellite provides support to family child care providers and the families
enrolled in their care. Services for providers include: City of Madison Accreditation, consultation, respite, equipment &
toy loans, training, and a referral system. Services for parents include: referrals, information on child development,
consultation, and mediation. Providers and parents become members of Satellite Family Child Care. Membership fees
may be waived or reduced dependent upon income eligibility.
Initial when reviewed: Parent _____ Provider ____
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