AGREEMENTDay Care Agreement • February 15th, 2012
Contract Type FiledFebruary 15th, 2012NAME OF CHILD: FEE AMOUNT $: PER-DAY-WEEK: DAY PAYMENTTO BE MADE: Services to be provided as part of the day care fee (examples: care, meals, transportation, etc.) Child'sArrival Time Child'sDeparture Time Person(s) Designated by Parents to Whom Child May Be Released Late Fee $ Per Min-Hr Extra services to be provided at an additional fee if applicable I, the parent/guardian: received complete written program information at the time of enrollment (§ 3270. 121, 3280. 121, 3290. 121) agree to update the emergency contact/parental consent form information whenever changes occur or every 6 months at a minimum (§ 3270. 124, 3280. 124, 3290. 124) Singature - Operator Date Signature - Parent or Guardian Date