financial

Child's Name ______________________________ Date of Birth _________________________

Non-Refundable Registration Fee of $25 Paid Date _______________ Check #____________

Non-Refundable Security/Holding Deposit (totaling 2 weeks fees) $_____________________
(Refundable as credit towards child's last two weeks of care when proper termination procedures are followed � see contract) Deposit Paid Date __________Check # _________ Amount $__________
Rate $____________________Per Week or Per Day (Circle One)

For contracted hours (See below) Additional hours available @ ________________ PER HOUR (This applies to hours above and beyond contracted dates and hours, including APPROVED early drop off or late pick up)

THERE IS AN AUTOMATIC 5% INCREASE IN ALL FEES ON THE FIRST MONDAY OF JANUARY EACH YEAR.

Payment must be made by 5:30 PM on Friday for the following week. The fee will be paid regardless of absences (including illness and/or family vacations). You will also be required to pay during the provider�s vacations � see contract.

You must give at least two weeks written notice before terminating services. If written notice is not give AND all terminating policies followed, you will forfeit your Security/Holding Deposit. Registration is NON-REFUNDABLE at any time.

I do not maintain regular operating hours. My hours are based on the needs of my current families on an individual basis. Please figure your working hours plus fair commute time and put the "scheduled hours" below. These hours should not exceed 10 hours per day. This will be the agreed upon schedule. Your contracted hours are _____________________________________. Your contracted days are ____________________________________________________________. You will be responsible to pay for the contracted days/hours regardless of attendance, holidays, etc.

If you need to drop off earlier than scheduled or pick up later than scheduled, you must discuss this with me and receive approval AT LEAST 24 hours in advance. Additional fees will apply. (See above for fees for approved overtime care.)

A late fee will be charged for dropping off or picking up later than the agreed upon contracted time. Time with my family is precious to me, as yours is to you. Current late fees are $15 for the first 15 minutes or any portion thereof, and $1 for each additional minute, and are per child. Please do not make me ask you to pay this fee since this charge is clearly stated and you should know when you owe it. Early drop off or late pickup may result in termination! I am not obligated, nor do I desire to work overtime!!!!

A late charge of $10 will be charged if payment is not received by 5:30 PM on Friday of each week. An additional charge of $10 will be added each day thereafter (including weekends) that payment is late. It is inconvenient to do my bookkeeping on several days each week. Continued late payments will result in termination of this contract and forfeiture of Security/Holding Deposit. Childcare will not be provided until all fees are paid.

I hereby agree to all terms set forth herein.

___________ ________________________ ________________________ ___________________
Date             Parent Signature                Social Security #                  Driver�s License #

___________ ________________________ ________________________ ___________________
Date             Parent Signature                Social Security #                  Driver�s License #

___________ ________________________ ________________________ ___________________
Date             Provider Signature              Social Security #                 Driver�s License #