| MYLITTLEPLAYLANDPROVIDERAND PARENTCONTRACT |
 |
| MY LITTLE PLAYLAND PROVIDER AND PARENT CONTRACT I, VELVET XXXXXXXXXXX, PROVIDER FOR MY LITTLE PLAYLAND, WILL PROVIDE CHILD CARE ACCORDING TO NY STATE REGULATIONS SET FORTH IN REGULATION PACKET PART 417 FAMILY DAY CARE HOMES AND IN MY LITTLE PLAYLAND'S PARENT HANDBOOK. I WILL CARE FOR CHILD STATED BELOW WITH ONLY GOOD INTENTIONS AND NO DISCRIMINATION OR ANY ABUSIVE ACTS. DATE:_____________________________________________ PROVIDER SIGNATURE:__________________________________________________________________ I, PARENT/GUARDIAN (PRINT) MOTHER________________________________________________________________________________ FATHER_________________________________________________________________________________ GUARDIAN 1____________________________________________________________________________ GUARDIAN 2____________________________________________________________________________ WILL PROVIDE PAYMENT AND ITEMS ACCORDING TO MY LITTLE PLAYLAND'S PARENT HANDBOOK. I WILL PROVIDE THESE IN A TIMELY MATTER AS STATED IN SAID HANDBOOK. I AGREE TO RECIEVE CHILD CARE SERVICES FROM VELVET XXXXXXXXXXX. I WILL ABIDE TO REGULATIONS SET FORTH IN MY LITTLE PLAYLAND'S PARENT HANDBOOK.ALL OF WHICH WILL APPLY FROM DATE OF CHILD CARE TO START UNTIL DATE OF CHILD CARE TO STOP STATED BELOW. PARENT/GUARDIAN SIGNATURES: DATE: MOTHER:________________________________________________________________________________ FATHER:________________________________________________________________________________ GUARDIAN 1:____________________________________________________________________________ GUARDIAN 2:____________________________________________________________________________ ABOVE RIGHTS ARE FOR STATED CHILD AND ONLY THIS STATED CHILD ON THIS CONTRACT. CHILD'S INFO ALL ARE REQUIRED NAME (FULL):___________________________________________________________________________ DOB:______________________________________________SS#:__________________________________ DATE CHILD CARE TO START:____________________________________________________________ TODAY'S DATE:_________________________________________________________________________ BELOW TO BE COMPLETED AT END OF CONTRACT WITH A FULL TWO WEEK NOTICE GIVEN. DATE CHILD CARE TO STOP:________________________________ I, VELVET XXXXXXXXXXX WILL NOT PROVIDE CHILD CARE TO SAID CHILD ACCORDING TO STOP CHILD CARE DATE STATED ABOVE AND WILL NO LONGER RECIEVE PAYMENTS FROM SAID PARENT/GUARDIAN STATED ABOVE. END OF CONTRACT COMPLETE WITH DATE OF CHILD CARE TO STOP AND SIGNATURES AGAIN FROM ABOVE PARTICIPANTS OF THIS CONTRACT. SIGNATURES TO END CONTRACT: DATE: PROVIDER:______________________________________________________________________________ MOTHER:_______________________________________________________________________________ FATHER:________________________________________________________________________________ GUARDIAN 1:____________________________________________________________________________ GUARDIAN 2:____________________________________________________________________________ |
| Email me Back to Start Page Back to Site Map Back to Forms Page |