Child Care Agreement
1Parent/Gmiirrdlna111 Name:.
Social Security#--------------------------------- '--
Address:.
-,--
Employer !Name and Address:
Child(ren) Names and DOB 1.
2., 3..
4..
5.
- 7., _
STATEMENT OF SERVICES: I have received a copy of the Statement of Services and Tuition Schedule and have been made aware of the policies of the center as regards all matters mentioned therein. I have read
and agree to abide by the rules and regulations of Nana's Place while my chilid(ren) are enrolled here.
IHOURS: I agree to adhere strictly to the hours of_____A.M[] PM[] toAM.[]P.M.[] on the following
days: (circle) Daily SM 'f W TH _F S. Should any changes occur, I agree to let Nana's Place know in advance of the changes. I understand that
.my childcare services cam not exceed 10 hours per day. I also understand that. if am
outside of my , scheduled drop off time, services may be denied.
Tuition: I agree to pay Nana's Place the tuition/fee of _ per week on every Monday prior to my child(ren)'s care. i understand that Child Care Services ‘Will not be available to me nor will my child be
allowed to attend if the fee is not paid in advance each week. I further understand that the tuition/fee, as above, is for the space reserved for my child(ren), and that IS due whether my child is in attendance or
not. I also understand that there are no exceptions to this rule. Up to two weeks of vacation per year may be used by paying a holding fee of 50% of tuition due. No refunds.
LATE FEES: I agree to pay a late fee of $5.00 per day (until the outstanding balance is paid in full) if my bill is not paid in full at the beginning of the week or a prearranged or When my child is dis-enrolled. I
understand that payments are first applied towards late fees, next towards overtime and other payments due. if my account is delinquent for over a week, my child may be dis-enrolled. I agree to pay a processing fee of $25.00 for returned checks, along with collections and other fees charged to Nana's Place. Also will be required to pay by cash or money order for the next three months. Only full payments are accepted after disenrollment. NO REFUNDS
FOR DES PARENTS ONLY V: I agree to pay the tuition co-pay of
per week that the IDES requires me to pay. The co pay is due for space reserved and is due irrespective of my child's attendance. I further understand that I am responsible for paying the full fee amount should IDIES not pay- for the days my child(ren) is or is not in attendance for any reason. I understand that DES pays for 2 absences' and i am responsible for all other payments when my child(ren) is not present. NO REFUNDS.
'By -participating in a Nana's Place and it's event or by failing to notify' us, in writing, your desire to not have your photograph used by us,)'OU are agreeing to release, defend, hold harmless and indemnify Nana’s Place from any and all claims involving the use of you or you1·child(ren)picture or likeness.
I fully understand that this is a legal binding contract and I agree to abide by it.
Parents Name:.
Signature:
!Date:
_
\Provider Signature:
Date:.
_
