CHILD CARE SCHEDULE, PAYMENT & FEE AGREEMENT
CHILD CARE SCHEDULE, PAYMENT & FEE AGREEMENT
I, ____________________________________ and __________________________________,
Parent or Guardian Parent or Guardian
agree to pay $ ______________ per _____________, due on _____________, for child care
as scheduled below to _______________________________.
Provider’s name
1) In the event my child or children are cared for at times additional to those scheduled, I agree
to pay an additional overtime charge per hour $ ____________ due ___________________.
2) Additional fees agreed upon: Registration $_______________ per ______________,
Activity/Material $___________ per _________, Deposit $__________for ________________
3) I understand I will be expected to pay the costs of regular child care whether my child or children are in care or not to hold the slot(s) in my provider’s business. Yes/No, initial ________
4) This will include my and the provider’s vacation times. Yes / No initial __________
5) This will include my child’s or family sick time. Yes / No initial __________
6) I agree to give my provider _______________notice for sick days, _____________ notice for vacation days, and _______________ notice for termination of services.
7) My provider agrees to give me _______________ notice before any change is made to charges or fees, and will provide me with a new Agreement in the event of a change.
8) My provider agrees to give me _______________ notice for personal/vacation time.
Child Care Schedule:
Child #1 Name _________________________________
Days & hours ______________________________________________________
Child #2 Name __________________________________
Days & hours ______________________________________________________
Child #3 Name __________________________________
Days & hours ______________________________________________________
___________________________________ _________________________________
Parent’s Name Provider’s Name
___________________________________ _________________________________
Parent’s Signature Provider’s Signature
___________________ ___________________
Date Date
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