Admission and Financial Agreement Sample Contracts

Contract
Admission and Financial Agreement • December 23rd, 2014

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, and Disclosures and Authorizations

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Contract
Admission and Financial Agreement • December 17th, 2012

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, and Disclosures and Authorizations

NURSING FACILITY ADMISSION AND FINANCIAL AGREEMENT PACKET
Admission and Financial Agreement • December 23rd, 2014

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, and Disclosures and Authorizations

Contract
Admission and Financial Agreement • June 7th, 2018

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, Disclosures and Authorizations.

Contract
Admission and Financial Agreement • January 6th, 2022

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, Disclosures and Authorizations.

Admission and Financial Agreement 2022-23 (Please keep one copy for yourself)
Admission and Financial Agreement • May 24th, 2022

Brush Creek Nursery School is a private, non-profit nursery school. Our facility number is 490 105414. We start late August through mid-June, M-F from 7:30 am to 4:30 pm. Classes for 3-yr olds are MWF 9-12, TTH 9-12, MWF 1-4 and TTH 1-4. Classes for 4-yr olds are MWF 9-12, TTH 9-12, TTH 1-4 and MWF 1-4. We are closed for major holidays, 2 wks for winter break (Dec/Jan) and one wk for spring break. Our Early/After Care program is available from 7:30-9 am and 12-4:30 pm and can be used on an as needed or on a contractual basis. The tuition for MWF is $410/month and $310/month for TTH. Non- contract Early/After Care is $11.00 an hour and contract Early/After Care is $9.00 hour. If a child stays at Brush Creek past 1 pm there is a required time block of 1-3 pm that is billed whether used or not. If only staying for lunch, you are billed 12-1pm.

Contract
Admission and Financial Agreement • June 2nd, 2021

Includes Advance Directives Information and Forms, Resident Rights Statements, Notice of Privacy Practices, Assignment of Benefits, Medicaid Application Overview, Application and Financial Worksheet, List of Texas Nursing Facility Posting Requirements, and Numerous Sample Policies, Disclosures and Authorizations.

ADMISSION AND FINANCIAL AGREEMENT BETWEEN FREEDOM CHRISTIAN SCHOOL AND…
Admission and Financial Agreement • February 6th, 2017

The admission agreement is made between Freedom Christian School and the parent(s) or legal guardian(s) of the student. In consideration of the services provided by Freedom Christian School, the parent or guardian agrees as a condition of enrollment of their student(s) to abide by the terms and conditions of this as follows:

Admission and Financial Agreement 2021-22 (Please keep one copy for yourself)
Admission and Financial Agreement • May 21st, 2021

Brush Creek Nursery School is a private, non-profit nursery school. Our facility number is 490 105414. We start late August through mid-June, M-F from 7:30 am to 5:00 pm. Classes for 3-yr olds are MWF 9-12, TTH 9-12, MWF 1-4 and TTH 1-4. Classes for 4-yr olds are MWF 9-12, TTH 9-12, TTH 1-4 and MWF 1-4. We are closed for major holidays, 2 wks for winter break (Dec/Jan) and one wk for spring break. Our Early/After Care program is available from 7:30-9 am and 12-5:00 pm and can be used on an as needed or on a contractual basis. The tuition for MWF is $405/month and $305/month for TTH. Non- contract Early/After Care is $11.00 an hour and contract Early/After Care is $9.00 hour. If a child stays at Brush Creek past 1 pm there is a required time block of 1-3 pm that is billed whether used or not. If only staying for lunch, you are billed 12-1pm.

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