NAME / ADDRESS
RELATIONSHIP
PHONE
1.___________________________________________________________________________________________________
2. __________________________________________________________________________________________________
3. __________________________________________________________________________________________________
· PLEASE MAKE THE ABOVE PERSONS AWARE THAT ID WILL BE REQUIRED.
DOCTOR __________________________________________________
PHONE # ________________________________
HOSPITAL CHOICE _______________________________
INSURANCE CO. ___________________________________
POLICY # ________________________________________
INS. PHONE # ______________________________________
· IF MY CHILD SHOULD MEET WITH AN ACCIDENT OR ILLNESS WHILE AT/ UNDER THE CARE OF LIL’ PEOPLE DAYCARE
CENTER, INC. AND I CANNOT BE REACHED, I AUTHORIZE THEM TO SECURE EMERGENCY MEDICAL
CARE. THE PARENT SHALL ASSUME RESPONSIBILITY FOR PAYMENT OF SERVICES.
PARENT SIGNATURE_______________________________________________
DATE ____________________
DIRECTOR’S SIGNATURE __________________________________________
DATE _____________________
REV12/99
PARENTAL AGREEMENT
WELCOME TO LIL’ PEOPLE DAYCARE.
We ask you to familiarize yourself with the Center’s policies and procedures in the Parent Handbook
and in this Parental Agreement.
1.
Lil’ People Daycare Center, Inc. agrees to provide childcare for your child on a full-time basis from
the hours of 6:30a.m. to 6:00p.m. Monday through Friday on a twelve-month basis, excluding posted holidays and closings due
to inclement weather.
The center closes at 6:00p.m. anything after is considered late. A fee
of $1.00 per
minute is charged and is due prior to the child’s return to the center.
2.
Parents agree to promptly provide and maintain accurate enrollment information and on-going record information. Immunization forms must be provided within the first 30 days of enrollment.
3.
Parents agree to pay the weekly fee for their child /children on Monday for that current week. After Tuesday tuition will be considered late and a $5.00 late fee will be applied that will accumulate
weekly. By Wednesday we must have a payment in full or a check to hold (w/appropriate late fees) in order for the child
to attend the center. Full time tuition includes two snacks (child must be in
the center before 8:30am & pm snack after nap) and a lunch. No outside lunch may be brought unless a medical or religious
reason exists.
4.
An enrollment fee per child will be charged annually.
5. Checks returned by the bank for ANY reason are subject to a $28.00 return check
charge effective 7/1/01. Additionally the cost will also include a late fee of $5.00
per week that the funds are being held up. These charges must be paid at the same time that the funds are either redeposited
or replaced with cash or a money order. The late charges will accumulate. Repeat
offenders may be asked to present cash or money orders instead of checks. All fees are
subject to change.
6.
Fraudulent checks will be prosecuted with the State Attorney’s
Office. Any fees that are charged by a collections agency or legal fees involved in the collections process will be paid
by the Parent's above what is owed.
7.
Parents agree to provide written authorization, before any medication can be dispensed to a child. All medicines will have a prescription label as well as the child’s name, RX number, dosage amount,
time to be given. All medicine will be in its original container.
8.
Parents or authorized persons will always escort a child from the Center. If parking in the “KISS &
GO” lane please do not get out of your car. If you need to come inside the center please park the car. Kiss & go
is to expedite the traffic.
9.
Parents must inform the Center of any change in phone numbers, work location, emergency contracts, or child’s
health status.
10.
Parents of infants agree to label all bottles with date and child’s name, provide diapers, food, supplies
on a timely basis; and to provide a pacifier if needed.
11.
Any field trip sponsored by Lil’ People Daycare Center will require a parental signed permission slip
in order for the child to participate.
12.
The terms above are subject to change from time to time in accordance with the Policies of the Center. You will be notified of any changes made.
13.
The school may refuse to accept, for care, any child showing signs of illness.
The
right is also reserved to refuse or to discontinue attendance of any child for any
reason.
YOUR SIGNATURE
ON THIS FORM IS AN ACKNOWLEDGEMENT THAT YOU AGREE TO COMPLY WITH LIL’ PEOPLE’S TERMS, POLICIES AND PROCEDURES
AND HAVE RECEIVED A COPY OF THE PARENT HANDBOOK.
CHILD’S NAME ______________________________________
PARENT’S SIGNATURE _______________________________
DIRECTOR’S SIGNATURE _____________________________________________
DATE _______________________________
Rev 9/07
