Child Care Agreement Template printable pdf download

Child Care Agreement

I, _________________________________________________________, the legal guardian of

_________________________________________agree to the following:

(Initial all that apply)

__________Pay fee per day/per week of _____________.

__________Day payment to be made is _____________________.

__________Volunteer to work _____________________ hours a week with the program.

__________ Follow the procedures in the program handbook.

__________Obtain a Special Care Plan, if applicable.

__________Services to be provided as part of the child care fee (transportation, meals, etc.)

are:_____________________________________________________________________________

________________________________________________________________________________

__________Child’s arrival time _________________Child’s departure time________________.

__________ Pay a late fee of, when applicable $ ___________________________.

__________ Obtain and provide records of health assessments/immunizations for my child according

to the schedule recommended by the American Academy of Pediatrics.

__________Cooperate with_____________________________in the follow-up of any medical,

dental, and/or developmental needs of my child.

__________Notify the staff when my child is ill or any family member has a reportable contagious

disease.

__________Complete a medication consent form when requesting medication administration by child

care staff.

__________Provide the program staff with ________________________________necessary for my

child’s care. (linens, clothing, toothbrush)

__________Provide information on how to contact me in an emergency situation, which I will update

every 6 months at a minimum and when changes occur.

__________Agree to discuss my concerns with __________________________________.

(staff member’s name)

__________Notify a teacher and sign my child in and out every time my child arrives and departs with

me or an authorized person.

Child Care Agreement Template