Enrollment Contract
This is an agreement between:
Jaymi Greenlee
AND:
Mother’s Name: ___________________________________
Home Phone: ___________________________________
Work Phone: ___________________________________
Cell Phone: ___________________________________
Father’s Name: ___________________________________
Home Phone: ___________________________________
Work Phone: ___________________________________
Cell Phone: ___________________________________
Address: _____________________________________
_____________________________________________
_____________________________________________
For the care of the following child(ren): (Names and current ages)
______________________________________________________
______________________________________________________
______________________________________________________
Emergency Contact (If a parent cannot be reached):
______________________________________________________
______________________________________________________
The terms of the agreement are as follows:
Days & Hours of care (These are the hours you will be charged for.)
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
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to |
to |
to |
to |
to |
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Child 1 weekly cost-$_______
Child 2 weekly cost-$_______
Child 3 weekly cost-$_______
The TOTAL weekly cost for all children is $___________.
There will be a $_________ fee per LATE PICKUP for ALL children.
These fees will be paid in advance, when the child(ren) is/are dropped off.
There is no refund for payments made in advance. However, overpayments will be added to the child’s “account”.
Fees will be paid with cash or money order.
Breakfast, lunch, snacks and drinks are provided for children over 12 months of age, and included in the daily rate. Parents are asked to provide formula and baby food for infants.
Parent Signature: ___________________________________________
Parent Signature: ___________________________________________
Provider Signature: __________________________________________
Date: ____________________________________________________
