Parent and Provider Contract/Enrollment Application

Date of application ______________________________ Date of start date _____________________________

Child’s name _____________________________Age _________ Sex _________ Birth date _______________

Home address__________________________________________ City/Zip ____________________________

Parent Name 1 _____________________________________________________________________________

Home Phone _______________________ Mobile _______________________Work _____________________

Email Address _____________________________________________________________________________

1. Daycare Payments can be made by cash or check made payable to [INSERT YOUR BUSINESS NAME

HERE].

2. We are open Monday through Friday (7:30am to 5:30pm). I/We will be need childcare for our child

normally beginning at ____________o’clock and ending at __________o’clock.

3. Please mark the days of the week you will need childcare.

o Monday

o Tuesday

o Option 2: I/We prefer to pay monthly (due on the 1st of each month).

Note: To figure out the monthly payment you do the following (weekly amount × 52 weeks ÷ 12 months).

5. Our weekly or monthly selected tuition price is (refer to price sheet) $_____________.

6. The amount of the deposit equal to two weeks of payment for childcare is $_____________. The amount of

the deposit listed will be credited towards the last two weeks of enrollment.

Persons other than parents authorized to pick up your child from [INSERT YOUR BUSINESS NAME

7. The Following subjects are of special concern to us. Both parents/custodians please initial each. Your

initials indicate each subject is read, understood, and agreed upon.

A. (______) (______) DIAPERS/WIPES: It is the parent's responsibility to provide diapers, wipes, and

diaper cream for your child. It is also the parent's responsibility to check periodically to see if or

when your child needs more diapers, wipes, and cream, (not the providers). Each child has his or

her own labeled diaper bin, either in the infant/younger toddler room or older toddler/preschooler room,

depending on the age of the child.

B. (______) (______) SHOES: Younger children love to take off their shoes. It is for this reason that we

outside of our full control, parents hereby resolve [INSERT YOUR BUSINESS NAME HERE] of

all responsibility for the shoes safe return and/or the ensuing scavenger hunt.

C. (______) (______) TRIAL PERIOD: The first 30 days of your child’s enrollment will be regarded

as a trial period, in which case either party may terminate the contract without notice. Each child

responds differently to a new environment, new children/providers, and moms/dads absence. We are

patient and good at what we do, so most of the time this is a non-issue. However, there are rare times in

which we must consider the well being of the group (the other children in our care). If for whatever

reason, either party feels our childcare environment may not be the best fit, either party reserves the

right to utilize this time period as a trial and terminate the contract without resentment, judgment, or ill-

This helps us tremendously. Reason being, unlike childcare centers, we can only take a limited amount

of children. So when we are full we are forced to say NO to all incoming requests for childcare. If we

have advance notice of discontinuation of needed services then it is possible for us make future

arrangements with new family’s inquiring about daycare for their child. This helps to keep our open

spots fluctuation to a minimum, and helps us be able to focus more on being the best childcare providers

our children’s soccer, baseball, karate, and wresting games/practice. So please be considerate of our time

when budgeting yours. If your late to pick up “once in a blue moon”, because of bad traffic or whatever,

we understand and no hard feelings. But if late pickups become a regular occurrence, then we may not

be the best fit for your childcare needs, and we may be forced to terminate our childcare arrangement.

G. (______) (______) GUIDELINES REQUIRING EXCLUSION FROM DAYCARE: A child with

any of the following illnesses must be completely free of any symptoms before returning to

daycare. If your child is taking antibiotics for an illness, your child may return to daycare after the

initial 24 hours of beginning antibiotics as long as he or she has a slight to no fever (under 100F under

the arm), no longer contagious, and is otherwise feeling well enough to participate in our daily schedule.

Signs of illness include the following; unusual lethargy, irritability, persistent crying for no reason,

runny nose (more than clear), cough (more than slight), difficulty breathing, diarrhea, vomiting, mouth

sores, rashes (note from doctor stating non-contagious is ok), pink eye, chicken pox, mumps, measles,

roseola, hepatitis A, impetigo, lice, ringworm, scabies, strep throat, scarlet fever, tuberculosis, shingles,

and any other contagious disease or rash. Any child with a fever of 100 degrees or above, orally (in

control of a room full of two year olds. Children act up considerably when other parent’s are present. If

you linger this makes our job much harder. Please understand, we are a home daycare, and not a

mommy and me class. If you feel the need to run around and play with kids, then may we suggest you

take your child to a park and/or open your own daycare. (b) Please send your child clean, dressed (no

pajamas, unless you don't mind your child wearing their pajamas all day), fed and ready for the day, as

well as all of your child's necessary supplies needed for that day's care. (c) Never leave without telling

your child goodbye (don’t sneak out). (d) Please be in control of your child during drop-off and pick-up

times.