General Information:
While
in my care your child will have the opportunity to participate in a wide
variety of activities, which promote all aspects of development. Family
childcare provides for children the comfort and experience of belonging to an
extended family. I provide a home like setting; therefore I do not follow a
strict routine. My approach to childcare is child centered and child directed.
Children are offered choices whenever possible. Your child may bring home a
calendar each month, with special events. Just because you are not seeing
anything in the way of papers does not mean that we have not been busy all day.
I am a Professional Child Care Provider,
as well as the teacher, the nurse, the janitor, mediator, dishwasher, fire
marshall, musician, counselor, friend, reader, safety instructor, activity
director, waitress, storyteller, life saver, dietician, chief cook, and bottle
washer. But I also get to play with
little people and legos, wear short and t-shirts to work and get lots of hugs
and kisses all day long.
About Me and My Family:
Brian and I have
been married for 5 years. We have one son,
Ian, who is 4, and one daughter, Emma who is 1.
Brian was born in Wabasha, and raised in Rochester, MN. He works for Qwest Communications. I was born and raised in a small town in
northwestern Pennsylvania. I have been a Licensed Practical Nurse for
over 10 years. I decided I wanted to
stay home with my children and also take care of others since I love being with
children, and I also wanted to spend more time with my own.
Brian and I have
several nieces and nephews who are very special and dear to us.
We do not smoke in
our house and do not allow it. We also
do not have any guns in the house. I am
hoping that this answered some of your questions and please do not hesitate to
ask me anything! I will be looking forward to taking care of your child(ren).
Hours of Operation:
Lil?
Miracle?s Daycare is normally open from 7:00
AM until 5:00 PM
Monday through Friday. Hours of care will be contracted from child to child. If
it is a parents day off or they get off early, please pick your child(ren) up
by 4:30pm. Occasionally I will provide after hours care
and weekend care. Please contact me on
an individual basis for further information.
Although I will try to accommodate your request to extend your
contracted hours of care, depending on my schedule I cannot guarantee it. No childcare will be provided on the
following holidays:
New
Year?s Day
Memorial
Day
Independence
Day
Labor
Day
Thanksgiving
The
day after Thanksgiving
Christmas
Eve (close at 1:00 PM)
Christmas
Day and day after Christmas
*If
it happens where Christmas falls on a Saturday I will have the Friday before
off and if it falls on a Sunday I will have that Monday off.
The
above are paid holidays for Lil? Miracle?s Daycare if they fall on a contracted
day for your child. In addition, Lil? Miracle?s Daycare will close for 2 weeks
or 10 days of paid vacation per calendar year per child and may take 10
personal days (no charge) per calendar year. Notification of at least
2 weeks will be given prior to any closed days, with the exception of
emergencies or illness. There will be no charge when my children or I are
sick. Please have a backup childcare provider
for these occasions. Lil? Miracle?s Daycare is not responsible for finding
alternate care for your child. In the event that I will be away for a period of
time less than three hours (Doctor Appointments, errands, etc.) substitute care
will be provided by my licensed subs, Brian(My husband), Jennifer(My
sister-in-law), and an approved Substitute Provider. You will be notified if a Sub is coming to
cover prior to me leaving.
Definitions:
Before/After
School: Includes breakfast and afternoon snack. Any day that school is not in session, a full
day rate will be charged.
No
Show: If your child will not be attending Lil? Miracle?s Daycare, a one
half-hour notice of absence is appreciated.
Drop
Ins: I do except children if I have the open spot for them.
Full-time: Childcare contracted on a
set scheduled time 4-5 days per week, more than 4 hours per day.
Part-time: Childcare contracted on a
set scheduled time 3 days per week or, less than 4 hours per day.
Payment:
DUE ON MONDAY or your first scheduled
day of the week. Please make payable to:
Michelle Rand. Payments are currently
accepted in the following ways: Cash,
Checks, or Money Order.
NON-REFUNDABLE DEPOSIT Before your
child is admitted into Lil? Miracle?s Day Care a security deposit must be paid.
This deposit will be credited to your last week?s fee when you decide to depart
from Lil? Miracle?s Daycare.
WEEKLY PAYMENT GUARANTEED regardless of
child?s absence for any reason.
VACATION PAY is due before you leave
for vacation. Your funds will not be used/cashed
until your first normal day of the week.
NSF Checks:
Checks are always an acceptable form of payment until you present me with a bad
check. You are responsible for all charges I may incur from my bank as a result
of your bad check. Child Care will immediately be halted until you reimburse me
the amount of the check and all expenses that have incurred. Reimbursement will
be in cash only. Future payments will be required to be made in cash. There is
a $30.00 NSF fee.
Extra Charges:
Late
payment charges- There will be a $5.00 late charge for each day your payment is
late.
Overtime
charges- will occur past the time of 5:00pm,
unless contracted later. A charge of $5.00 for every 10 minutes, or fraction
thereof, will be DUE UPON ARRIVAL!
Sick
Care Fee- $25.00, if not picked up within 1 hour of call.
If
supplies are requested and parents fail to bring them, I will purchase them and
add them to your bill.
Open Door/Security:
You
are invited and welcome to visit Lil? Miracle?s Daycare anytime your children
are present. You are asked to avoid visiting during Quiet Time as much as
possible. Because the layout of our home
does not allow me full eyesight of our entrance, I keep our front door LOCKED
during most of the day! This is done for the security of my home and the
well-being of the children. We ask that
you ring the bell and wait to be greeted when dropping off or picking up your
child. This is not a policy to keep you
from entering, but a safeguard to KEEP STRANGERS OUT! If you come into my home further
than the entrance, PLEASE REMOVE YOUR SHOES!
Parents are also free to call Lil? Miracle?s Daycare at any time. If I
do not answer the phone, please leave a message, and I will call you back as
soon as we are finished with the current activity.
Sick/Vacation Days:
In
the event that your child is ill and needs to miss a day, please call ? hour
before arrival time. Parent agrees to
provide 2 weeks notice prior to any vacation time. Parent agrees to pay
childcare fees to hold child?s position during any vacation time or extended
leave due to illness etc., up to 2 weeks per year. Full payment must be
received whether or not child attends.
Vacation (Families):
Full-time
children will be given one ? week rate, if a 2 week notice of vacation is
given. This does not apply to part-time
children, or summer care children. After
they are used, no other days will be allowed until one year has passed. All vacation days must be used together, not
individually. This time cannot be used
when I am taking my paid vacation.
Funeral Leave:
If
there is a death in the Rand?s immediate
family, up to 1 week of UNPAID funeral leave is allowed. Parents will be notified as soon as possible
to allow them to make alternate arrangements.
Maternity Leave:
I do not offer an unpaid maternity leave for family?s who
are home with a new infant. My business
and my income are based on my enrollment at all times. If you chose to keep your child who is
enrolled in my care, home during your maternity leave, the full weekly rate is
still due each week on Monday. If you
are planning to have a baby in the future, please ask me about my infant
opening status. I generally do not
provide infant care for families outside of my child care and typically have
infant openings available.
Maternity Leave for
provider:
If I take maternity leave, it will be no more than 6-8 weeks. Of course, that
may change due to health reasons or emergencies. This time is, of course,
unpaid to me. Again you will also have to find alternate care for that time.
Rate Increases/Annual
Fees:
There may be a time when I need to increase rates. You will be given at least 30 day notice
prior to an increase. Please keep in
mind that your childcare fees is not based solely on the care that is provided
to your child. It is also based on the
age of your child, the number of hours of care that is needed each week and
other costs associated with running my childcare effectively. These expenses include but are not limited
to: art/craft supplies, Preschool curriculum, training, taxes, insurance,
helper/substitute costs, relicensing fees, increase in utilities, and special
activities. A yearly fee of no more than
$25.00 per family is due November 1st each year.
Revisions
to Handbook and Contract:
There
will be a yearly revision to this handbook and the accompanying contract. A new
contract will be signed by all families each year. I reserve the right to make
changes in rates and policies, as I deem necessary. You will be notified, in
writing, of any changes that may occur. Every attempt will be made to give at
least two weeks notice of changes.
Television:
I
allow limited TV viewing consisting of Nickelodeon, PBS, Noggin, and the Disney
Channel only. On occasion I let the children pick a child appropriate video to
watch. Children are NEVER required to sit and watch TV, and TV is not offered
in place of Free Play or Learning Activities.
Guidance:
Some
people call it discipline, I prefer guidance. No child will be hit, spanked,
belittled, or otherwise intimidated at Lil? Miracle?s Daycare--even with
parental permission. No corporal punishment will be used. Children will be
treated with courtesy, respect, and patience. Guidance will be according to age
and understanding level. Younger children, babies and toddlers, will be
redirected to another activity. Older children will be given time outs
depending on the severity of the offense (almost always 1 minute per year of
age, never to be more than 15 minutes). If a child becomes a persistent
behavior problem, I will address it with you and we will try to resolve it
together. AT NO TIME WILL A CHILD BE SUBJECTED TO PHYSICAL PUNISHMENT OR
SHAMING, FRIGHTENING OR HUMILIATING METHODS BE USED, OR ANY TYPE OF VERBAL
ABUSE, THREATS, DEROGATORY REMARKS, OR DEPRIVATION OF A MEAL OR ANY PART OF A
MEAL BE USED. NO CHILD WILL EVER BE PUNISHED FOR TOILET ACCIDENTS.
Meals:
Breakfast
7:30 a.m.-8:00 a.m.
Lunch 11:30 a.m. - 12:00 p.m.
Afternoon Snack - 3:15 p.m.
These times are approximate.
I
participate in the Food Program sponsored by Child Care Resource and
Referral. I provide
nutritionally balance meals and snacks for your child and receive a small
reimbursement. Please do not send any food or drink with your
child without prior approval through the provider. Feed your child breakfast if you will be
arriving after 8:00AM. Children are encouraged to use this time to
share their experiences with each other. Manners are taught, and practiced
during this time as well. Please list on the medical report any food allergies
child may have. If your child needs a special diet, the parent must furnish
these foods. Infant formula used is
Parents Choice with iron (Wal-mart Brand).
Infants who require formula after their first birth date will remain at
an infant rate until they are taking total milk.
Activities:
Age
appropriate activities are scheduled with flexibility allowed to respond to the
needs of the individual child and day. I will offer times for outside play,
crafts, stories, instruction, and naps appropriate to the child's ages,
interests, and abilities. I will provide your child with tender loving care,
understanding, patience and guidance in a happy family setting. Chores, such as
picking up, putting dishes in the dishwasher will likely be a part of the day. We
do many arts and crafts where the focus is on the process, not the product.
Free play is an important part of a child's early years. It is here that they
learn social skills that will be needed the rest of their lives. There is a
tape/CD player for the children to use.
I encourage the school age children to read books privately or to the
other children.
An example of a day at Lil? Miracle?s
Daycare:
7:00AM-8:00AM:
Arrival, Free play (quiet play), TV time
7:30 AM-8:00AM: Breakfast time
8:00 AM-9:00AM: Circle Time/Preschool
Time
9:00
AM-10:00AM: Craft time, Music time, Computer time
10:00AM-11:15AM:
Outside time (weather permitting), inside play otherwise
11:15AM-11:30AM: Prep for lunch
11:30AM-12PM: Lunch time, Clean up
12:00PM-12:30PM: Free play, TV time, Story time
12:30PM-3:00PM:
Quiet time/Movie time
3:00PM: Wake up
3:15PM-3:30PM: Afternoon snack
3:30PM-4:30PM:
Free time, Computer time, Study time for older children, Outside time (spring,
summe, and fall only)
4:30PM-5:00PM: Clean up, Parent pick-up
House Rules:
1. No hitting, biting,
pinching, throwing, pushing, hair pulling, or otherwise hurting ourselves or
others.
2.
No intentionally breaking anything.
3. No running,
jumping, wrestling, climbing, etc. in the house or on the furniture.
4. No picking up
babies or toddlers.
5. No leaving the
house or yard without permission.
6. No name calling,
yelling, fouls language or teasing?everyone deserves to be treated with
respect.
7. All food and drink
will remain in the dining room/kitchen area.
8. Please treat my home and family with respect.
Dress Code:
Please
dress your child appropriately. The activities may be messy. Do not send your
child in clothing that you do not want stained. Weather permitting; we will
spend a lot of time outdoors. Make sure to include hats, mittens, boots, snow
pants, and coats for cold weather. You
also need to supply a complete change of clothing in case of an accident; I do
not supply clothing for day care children. If the child has no spare clothing,
the parent will be called to bring some.
Water
Play: I have a sprinkler for summer water play. A swimsuit will be requested
for these days.
House Cleaning:
My
house is not always spotless. My main
concern is the care of the children. I
clean my house during rest time, if all are asleep, during non-business hours,
and occasionally with children?s help.
The children will help clean up toys before meals and naps.
Transportation:
I
may transport the day care children, if the need arises. You will be notified and proper car seats
and/or seat belts will be used. I may
ask that you leave your car seat for the day.
Toys:
Please
refrain from sending any toys from home with your child. If your child needs a special toy or item for
sleeping, it will be allowed, but it will remain put away until Quiet Time. Lil?
Miracle?s Daycare assumes NO responsibility for lost, stolen, or broken toys
from home. Should the child deliberately destroy my toys or other property
through misuse or willfulness, the parent will be required to replace it.
Rest Period:
All
children will have a rest period. No child is forced to sleep, however they
must remain quiet. Older children, and
those who wake early, will participate in a quiet activity until Quiet Time is
over. Please try not to schedule pick ups or visits during this time to lessen
disturbance to the resting children.
Toilet Learning:
I
will assist you in toilet training your child with the understanding that it
will be successful only if we work together. I will use cotton underwear or
pull-ups supplied by the parent. Send your child ONLY in easy on/easy off
clothing until they are able to completely undress and dress themselves. I
require at least 2 complete changes of clothing during Toilet Learning. I do
not launder soiled items and will send them home in a plastic bag. Please
replace any clothing sent home the next day.
Holidays/Birthdays:
We
honor major holidays and all children?s birthdays. If you would like to bring a
special Treat for the children, please arrange this with the provider. You are
more than welcome to participate in ANY activities we have planned.
Confidentiality:
The
information you supply to Lil? Miracle?s Daycare will be kept confidential. I
will, at all times, respect your privacy. Before any of the information is
released to outside persons, the parents will sign a release form.
Non-Discrimination:
I
will not discriminate in relation to admissions of any child on the basis of
race, creed, color, national origin, religion, or sex.
Photographs/Video Recording of Children:
Parents give permission to have the child
photographed, video taped, and/or voice recorded. These reproductions will not
be publicly viewed outside the daycare home (i.e. published in newspaper,
website) without the consent of all parties in the picture. See Photo Consent form.
Drug and Alcohol Policy:
I
prohibit employees, helpers, substitutes, and volunteers, when directly responsible
for caring for the children from abusing prescription medication or being in
any manner under the influence of a chemical that impairs the individual?s ability
to provide services or care. I will
train employees, helpers, substitutes, and volunteers about this drug and alcohol
policy.
Back-to-Sleep (SIDS Prevention):
The Back-to-Sleep campaign began in this country in
1994 to promote the message that babies should sleep on their backs, not on
their stomachs, to reduce the risk of SIDS. Since then, the number of
babies dying from SIDS has decreased by more than 40%. According to state
regulations, all infants must sleep in a pack-and-play or a crib, no sleeping
in swings or car seats are allowed. It is a practice at Lil? Miracles
Daycare that babies are placed on their backs for sleeping in a
pack-and-play. Babies should be kept warm, but they should not be allowed
to get too warm; therefore, if needed, a light blanket will be used. No
toys or stuffed animals will be allowed in the pack-and-play.
Emergencies:
Fire:
There is one fire extinguisher located in my home. It is in the kitchen under
the sink. If there is a fire that cannot be extinguished quickly, the children
will be evacuated immediately before calling 911. We will practice fire drills
monthly so the children will be prepared in the event of a fire. The fire
evacuation plan is located on file and you are free to view it at any time.
Tornado:
In the event of a tornado warning, the children will gather in the basement. We
will remain in the basement until the inclement weather has passed. Tornado
drills will also be practiced monthly. The tornado plan is located on file and
you are free to view it at anytime.
Power
outage: There are flashlights located in the upstairs and downstairs. If the
power remains out for some time, there are non-perishables located in the
kitchen that will be used to eat. If the weather is inclement and the house is
getting too cold for the children, you will be called to pick up your child.
Mandated Reporter:
As
a Childcare Provider, I am required by law to report any suspected signs of
child abuse and/or neglect. This includes any form of physical punishment by
the parents in my home. See attached
Reporting policy for licensed family child care program.
Supplies:
All supplies must be labeled with your
child?s name. You will need to provide the following things to be left
here:
1.
1 complete change of clothing (more if we are toilet training) to be left here.
This includes shirt, pants/shorts, socks, and underwear.
2.
Any over the counter medication that you may wish to be used. This must have
the child?s name on it. Remember, I will always ask your permission before
administering.
3. Comb or Brush.
4. Blanket, if they use specific/special one,
otherwise one of mine will be used.
FOR CHILDREN YOUNGER THAN 18 MONTHS
(and those not yet potty trained and/or weaned from the bottle)
1.
Diapers or Pull-ups, 1 full package. They will be stored in your child?s cubby
and I will notify you when the supply is low.
2. One tub of Wipes. They will be stored in your child?s cubby,
and I will notify you when a refill is needed.
3.
1 pacifier and pacifier fastener to be left here, if these are used.
4.
2 changes of clothing (T-shirt, sleeper, outfit, and socks). Careful attention
must be paid to maintain current sizes left here. I will notify you when more
are needed.
5.
Any cream, powder, etc. that you wish me to use.
6.
Baby Tylenol or Orajel, if you wish it to be used.
7.
Comb or Brush.
8.
Baby Formula/Breast Milk, Cereal, or Baby Food, if you are supplying.
9.
Blanket, if they use specific/special one, otherwise one of mine will be used.
The
option of leaving these items here is for your convenience and is not required.
However, all of the above items are required for me to care for your child, so
they will need to be brought daily.
Medications:
No
child will be given any medication, prescription or over the counter, unless
written permission is given by the parent. Prescription medication shall have
the child?s name, name of medication, Doctor?s name, name of pharmacy,
prescription number, date, and directions for administering. The medication
must be in the original container as dispensed by the pharmacy. I have
Permission to Administer Medication forms to be filled out each time your child
will need medicine to be administered. Written permission is required in order
to use diapering products, sunscreen lotion and insect repellents.
EXCEPTION:
As your childcare provider, I will administer Syrup of Ipecac if instructed to
do so by poison control or emergency medical services.
Medical Emergencies:
Although
supervision is constantly given, I cannot be by the child?s side at all times
to prevent falls, tripping, bumps, blows from other children, etc. If the child
is injured in a non life-threatening way, I will assess the child and provide
home first aid. If the injury is more serious, the parent will be notified so
the child can be transported to the hospital or doctors office. (I.e. needs
stitches, broken arm, or dislocation, etc.) All costs associated with injuries
to the child will be the responsibility of the parent, unless I have been found
to be negligent. In case of a medical emergency, I will attempt to contact you
immediately. If I am unable to reach you, I will start calling the people designated
as your emergency contacts. If I am unable to reach you or your emergency
contacts, I will transport your child to his/her doctor or to the hospital, if
necessary. If immediate intervention is required, I am certified in infant,
child, and adult CPR and First Aid and will take appropriate action including
calling 911 and having your child transported to the appropriate hospital. You
or your family's insurance is/are responsible for the cost of medical help or
treatment due to accidents or illness while in childcare.
Non-Discrimination:
As license provider, I shall not discriminate in relation to admissions on the
basis of race, creed, color, national origin, religion or sex.
Availability
of Regulations: A complete copy of the regulations that govern licensed day
care is available upon request from the office of the Olmsted County.
Insurance:
I
do carry liability insurance on my day care business. If you have any questions about this
insurance, please feel free to ask.
Swimming Pool:
I
do have a swimming pool on the property.
There are gates that have locks from either entrance of the pool. The pool is closed to daycare children unless
there is an individual agreement with parent.
See child enrollment paperwork.
Illness:
Many
illnesses are contagious. I will not
unnecessarily expose the children to them.
While I can appreciate your work related concerns, I am not in the
business of caring for sick children. Therefore, please DO NOT bring your child
to day care when they are not feeling well.
When the child is ill, they need their own environment and with an
adult who can give them their full attention.
Obviously, with other children in my care, I can not fulfill that role
for your child.
If
your child becomes ill during the day, you will be notified and a decision will
be made as to whether or not they should be sent home. If during the night or over the weekend your
child have been ill, I would appreciate being informed so I may watch them
during the day for continuing symptoms; other parents will be informed as
necessary. I will not hesitate to
request that you take your child home if your child appears too sick for day
care when they arrive. Finally, please do not expect me to make
the decision as the whether or not your child should be at day care!
Symptoms of illness can include, but not
limited to:
FEVER?This
is a temperature of 100 degrees F, or the fever requires medication at regular
intervals to control. I am unwilling to
care for a child who has a fever. A
child needs to be fever free for a minimum of 24 hours before returning to
child care; that means the child is fever free without the aid of Tylenol or
any other fever reducing substance.
VOMITING?.More
than the usual infant ?spitting up? is considered vomiting. Children must be vomit and fever free for 24
hours before returning to the day care.
DIARRHEA?This
is characterized by frequent watery or green-colored bowel movements which are
not related to meds or food reactions.
Even without other symptoms, I am unwilling to care for a child who has
diarrhea.
RUNNY NOSE?Your child may be
brought to care if he/she has a common cold (slight cough, clear runny nose,
occasional sneezing). Discharge of any color other than clear is not acceptable
in child care.
RASH?An
undiagnosed rash other that mild diaper rash or heat rash should be closely
watched.
STREP
THROAT?A sore throat that needs culturing because other signs are present means
that a child should not me at day care until the culture results are
known. I will be responsible for
notifying the other parents that their child has been exposed.
Re-admittance to day care for the following
communicable diseases shall be:
CHICKEN
POX?all lesions are dry and crusted.
IMPETIGO?(blister
covered with honey-colored crusts) No sooner than 24 hours after the start of
meds. If no improvement in 48 hours, the
child should be reassessed by a Dr.
CONJUNCTIVITIS?(pink
eye, redness of the eye with burning and thick purulent discharge) No sooner
that 24 hours after the start of meds and no drainage present.
LICE
AND SCABIES?The child can be re-admitted following medical treatment.
HEPATITIS?Physician?s
statement is required prior to re-admittance to day care. Minnesota
law requires that all children enrolled in a Minnesota day care home must be immunized
against polio, diphtheria, tetanus, pertussis, measles, and rubella. Before I can accept your child for care, your
must complete a record of immunization.
Immunizations must be current and the record kept updated.
In
the best interests of your child and the other children in my care, all health
care policies are STRICTLY ENFORCED! Your cooperation will be appreciated. Failure to comply with the health care
policies may result in termination of the placement agreement and loss of care
for your child.
Parent Responsibilities:
Please
bring immunization sheets when your child receives shots, in order to update my
records.
Address
or telephone changes for home or work must be reported ASAP!
Refrain
from sending your child with candy, gun, food or beverages! Special treats may
be brought for everyone.
Please
notify me as early as possible if your child will not be attending day care, if
you will be arriving late, or if someone other than yourself will be picking
your child up. If that person is not known
to me, please have them bring a photo ID.
I will not allow a child out of my care to a stranger.
Trial Period:
There
will be a two-week trial period, beginning on the child?s first day of
care. Either party may terminate this
contract within the trial period, without further obligation.
Termination Procedures:
Parents
will notify me in writing 3 weeks in advance if they are terminating this
contract and removing the child from day care.
The parents will be responsible for any and all collection fees,
including certified mail charges, postage, and small claims court charges as a
result of non-payment. The parents will
be responsible for the tuition fees if the child is in attendance or absent
during this termination period. The
provider will give 3 weeks written notice if the child is to be terminated for
any reason other than non-payment of tuition, which will take place
immediately. By giving your 3 week
notice, vacation time is forfeited, and therefore cannot and will not be
applied to the last three weeks when giving notice.
Teamwork:
As
parents and provider, we must work together to ensure that your child has the
opportunity to develop to their fullest potential in a warm, loving, and
nurturing environment. It is important
that we communicate effectively about your child. Your input on any issue concerning your child
is very much appreciated.
The
policies in this contract are necessary to ensure quality experiences for your
child and a good working relationship for me.
The previous pages are intended to detail those policies which establish
the framework for my child care business.
I
have expectations of you and hope these pages have helped to explain my
preferred way of doing business. While I
will not be arbitrarily changing policies, this contract is not meant to imply
that a policy, once developed, can never be modified or improved. Your comments and suggestions are always
welcome.
You
may review my copy of the Rule #2 for Family day care or you can request a copy
from Olmsted County Day Care Licensing Unit, 285-7009
I
look forward to a long and happy working relationship with you and your child.
Child?s
Name ___________________________________ Date of Birth _____________
Child?s
Name___________________________________
Date of Birth______________
Child?s
Name___________________________________
Date of Birth______________
I have read and understand this is a legal
and binding contract and accept all terms and conditions.
Parent
Signature ____________________________________
Date _______________
Parent
Signature ____________________________________
Date _______________
Provider
Signature __________________________________
Date ______________
Created: 12/31/02
Revised: 10/25/05
Handbook 2006