Ascension Lutheran Church
FINANCIAL RESPONSIBILITY CONTRACT FORM
2018-2019
Required to be completed in full
Child: ___________________________ Parent/Guardian:____________________________
Ascension Children's Learning Center bills based on contract, not attendance. It is the parent's/guardian's responsibility to give two weeks' notice to Ascension Children's Learning Center if there is a change in contract needs. Parents/Guardians are allowed to make one contract change per year (unless otherwise approved by the Director of Ascension Children's Learning Center).
A total of 10 vacation days per year (5 vacation days per summer for summer only enrollment) will be available for each family. Please refer to the parent handbook for use guidelines.
Standard Billing
____ 5 full days: $178.95/Weekly ____ half days $102.45/Weekly
____ 4 full days: $143.16/Weekly ____ half days $81.96/Weekly
____ 3 full days: $107.37/Weekly ____ half days $61.47/Weekly
____ 2 full days: $71.58/Weekly ____ half days $40.98/Weekly
____ Daily Rate $37.40 per day
____ Half day $22.00
____ Hourly rate $5.25 per hour - $100 pre-paid at time of enrollment
Fees are due the Friday prior to services being rendered.
*10% Discount given to additional children within a family and for church members.
CCCAP Billing:
____ Parent Share determined by CCAP Payment due on the 1st of each month
*CCCAP participants must provide the Ascension Children's Learning Center with approval prior to child(rens) first date of care.
** ACCOUNTS NOT KEPT CURRENT ON PAYMENT WILL BE SENT TO COLLECTIONS AND ALL CHILDCARE SERVICES WILL BE TERMINATED.
Billing Information:
Responsible Party:______________________________ Last 4 Digits of SSN:_____________
Address: ______________________________________________________________________
Phone #1: ________________________________ Phone #2: ____________________________
Drivers License #: __________________________ State of Drivers License: _________________
By signing below, I agree to the contracted days stated above. I am financially responsible for all childcare fees/charges incurred by my child’s participation at Ascension Children's Learning Center.
Parent Signature: __________________________________ Date: ___________________
Staff Signature: ____________________________________ Date: ___________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.