Sample Child Care Agreement Form
Sample Child Care Agreement
Welcome to my family child care home. The purpose of this agreement is to define the
mutual terms for child care arrangements. Please let me know of any changes of
address or telephone or emergency numbers. Parents are welcome to visit at any time
during child care hours.
Child’s name_____________________________ Date of birth___________________
Parent’s name(s) _______________________________________________________
Hours and Days of Operation
Child care services will begin on __________________________________, 20___
The hours for care will begin at ________a.m./p.m. and end at ______a.m./p.m. on the
If your child is going to be absent or late, please call in advance.
Child care will not be available on the following holidays: ________________________
My vacation period will be _________________. You will be responsible for making
other child care arrangements. Payment is still expected.
$____________ per week for full-time care.
$____________ per hour for regular, part-time care.
$____________ per hour for drop-in care, if space is available.
$____________ for late payment charged for any time after_______unless
special arrangements have been made.
$____________ per meal. Families are required to bring the appropriate foods
for infants younger than ________ months old.
Child care fees are payable in advance and are due no later than _________________.
Fees may be paid: weekly _____ bi-weekly _____ monthly ______.
An advance deposit of $ ___________ must be paid at the time of enrollment. This
amount will be returned when services are terminated.
Fees may be (or may not be) adjusted when services are not available because of
illness or vacation.
Sample Child Care Agreement Form PDF
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