| Mama Alouche Family Home Daycare Since 1984 |
| Contract |
| MAMA ALOUCHE DAY CARE SERVICES (Click HERE for printable version) "Your children are taken care of like Mama�s!" LAST REVISED: October 6, 2006 This contract must be completed in full and signed prior to beginning childcare with MAMA Alouche Day Care Services. Please ensure that all requirements of this formal agreement are understood in full prior to enrolling your children in this exciting childcare program. This contract consists of three sections: Section 1: Agreement Between Parent and Caregiver Section 2: Medical Consent Form Section 3: Authority and Release Form Section 4: Final Approval Please feel free to contact me via e-mail at [email protected] or phone 905 683-8240 for any clarifications of this contract prior to its completion. Section 1: Agreement Between Parent and Caregiver Fees � The weekly fee including statutory holidays, will be_____. Please be advised that failure to comply with the payment schedule will result in the immediate removal of your child from Mama's day care program. Payment method- Post dated cheques are to be submitted at the beginning of each month each week of the month requires one post dated cheques. Prepayment - 1 week payment is required in advance. This equals prepayment of the last week of childcare. Cancellation Notice � If either party must cancel, notice will be given one week in advance. Missed Days � If the child is absent, the full weekly fee will still be paid. Holidays � I understand that your and the child�s holidays are from _____________________________to___________________________________. The client will pay the full weekly fee regardless of whether I am or am not on vacation at the same time. However, if I am ill or am not able to provide day care services due to some incident then the weekly fee will be reduced accordingly. Times and Late Pick-Up Fee � You will bring ___________________________ to my home at ________________ A.M. and pick him/her up at ____________________ P.M. Punctuality and regularity are expected. If you are more than 15 minutes ate you will pay an overtime fee of $5 per 15 minutes in addition to your regular weekly fee. Sickness � If your child is too sick to be in the presence of other children or to participate in daily activities, I reserve the right to ask you to keep the child at home. Medication � Non-prescription and prescription drugs will be given only with the consent of the parents or doctor. Parent�s Signature: ______________________________________ Mama�s Approval: ______________________________________ Meals � As agreed upon I will serve a mid-morning snack, lunch and an afternoon snack. Breakfast and dinner are your responsibility. If I have to feed your child these meals then you will reimburse my expenses. Or, as agreed upon, you will supply the food for the day. If any other unforeseen expenses arise (diapers, medicine, etc.), it is your responsibility to reimburse me for any such expenses. Articles to be Supplied by Parents: Weekly supply of diapers, change of clothing, spare clothing for seasonal changes, baby food, formula, special diet foods, towel, facecloth, toothbrush, comb, special toys or items that the child uses as security, car seat, etc. Section 2: Medical Consent Form Name of Child: __________________________________________________________ Date of birth: ____________________________________________________________ Address:________________________________________________________________ Child�s OHIP #:__________________________________________________________ Doctor�s Name: __________________________________________________________ Doctor�s Phone: ( ) - . Doctor�s Address: -________________________________________________________ FATHER MOTHER Name:_________________________ Name:_________________________ Home Phone: ( ) - Home Phone: ( ) - _ Employer:______________________ Employer:______________________ Work Phone: ( ) - _ Work Phone: ( ) - _ Parent�s Signature: ______________________________________ Mama Approval: ______________________________________ Please include any information pertaining to allergies, regular medication, chronic medical conditions etc. (if applicable). Known Allergies: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Accidents or illness can happen and in the event that you are not available, I the day care provider ask you to give me permission to contact your doctor (as listed) or, if he cannot be reached, permission to contact another doctor to give the necessary treatment. Also, in the event of an emergency the following people can be contacted: Name:______________________________ Name:____________________________ Relation:____________________________ Relation:___________________________ Phone: ( ) - . Phone: ( ) - . If at any time, due to such circumstances as accidents, sudden illness or emergency, medical treatment is required, this may be given, including anesthetic, if necessary, by a private physician or hospital. Parent/Guardian:-------------__________________________________________________ MAMA�s Approval:_________________________________________________________________ Section 3: External Transportation I, _________________________________, hereby give Wadia Alouche permission to take my child/children on walks and special trips by T.T.C. and/or car at any period while my child is enrolled in the MAMA DCS program. Date:____________________________________ Child:___________________________________ Caregiver: Wadia Alouche Parent�s Signature:-___________________________________ MAMA�s Approval:___________________________________ Section 4: Final Approval I, _______________________________, hereby agree to all of the terms set forth in this contract and will abide to all requirements as long as the contract is honorable with the caregiver Wadia Alouche. I fully understand all of the issues addressed and will comply with them so long as I am a client of MAMA Day Care Services. Date:____________-___________________________________ Parent�s Signature:-___________________________________ MAMA�s Approval:___________________________________ |