Parent/Caregiver Contract - Sample #2
Submitted by Janet - Village Green Playcare Inc.

It is my/our desire to have my/our child/children enrolled in the daycare program at
(Daycare Name Here).

I/we have received a copy of the (Daycare Name Here) policy handbook. I/we have
read, understand and agree to abide by the policies contained therein. I/we also
understand that my/our child is being accepted on a two week trial basis. During this
time, the staff will make observations and evaluations pertaining to the child's ability to
adapt to the daycare surroundings. Unless otherwise notified, the child/children will be
accepted and permanently enrolled. I/we further understand that if the policies outlined
in this handbook were not adhered to, it would be sufficient cause for the removal of the
child/children from the daycare program.

I/we also agree to give a minimum of two weeks written notice (ten full daycare days) of
my/our intent to withdraw my/our child/children from the daycare program. If two weeks
notice is not given, I/we agree to make full tuition payment for the final two weeks.
Unpaid vacation/sick days cannot be applied to the final two-week period.

Please initial next to each item. We want to be sure you understand and agree to these

________ I/we understand that I/we must provide a completed medical form to the

________ I/we understand the daycare fees are __________ for school weeks and
__________ for vacation weeks.

________ I/we understand there will be extra charges during school weeks if there is a
snow day or late start or early dismissal.

________ I/we understand daycare payment is due Monday. Late fees are $5.00 per day.

________ I/we have contracted for the hours of __________ to __________ .

________ I/we understand the late pickup/early drop off fee is $1.00 per minute.

________ I/we understand the pick up policy for other than parental pick up.

________ I/we understand the illness policy. ________ I/we understand the meal policy.

________ I/we are contracting for (year round, school year only, summer only)

________ I/we understand the behavior policy and I/we have read and shared the daycare
rules with my/our child/children.

________ I/we understand the returned check policy.

________ I/we understand that I/we will make all payments during the first three months
of child care as none of the 10 non payment days may be used during this time.

________ I/we understand that if I/we are contracting for child care for the school
calendar usage - Sept. thru June, these 10 days without payment are not available to

________ I/we agree to pay the last two weeks tuition during the first two weeks of

________ I/we have contacted references.

_________________________ _________________________________
(Daycare Name Here) Parent/Date

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