Chid Care Agreement Form - Spanish
|CHILD CARE AGREEMENT |
| First Middle Last |
|Child’s name: |
| First MIddle Last |
|Parent or Guardian name: |
| |
|Days and times my child will receive care: |
|Check days of care |
| |Date payment due: |
|FEE: $ per: Hour | |
|Day | |
|Week | |
|Month | |
| |Source of payment: |
| |Parent |
| |Other (specify): |
|Overtime rate: $ per: per |Late fee: $ per: |
| |
| |
|I agree to promptly notify the child care provider of any changes of the above information. I understand that I am fully responsible for the terms of this |
|agreement as stipulated. |
| |
|I have read, understand and agree to comply with the policy and procedures and information for parents given to me by: |
| |
|Name of Licensee |
|Parent or guardian signature |Date |Parent or guardian signature |Date |
| | | | |
| |
| |
|I agree to provide child care services according to the above plan. I agree to promptly notify the parents or guardians of any changes to above information. |
|Licensee signature |Date |
| | |
|Street Address City State Zip code |
| |
| |
|Comments |
| |
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