Sample Child Care Agreement Form

How do you encourage positive behavior: ____________________________________

If your child attends school, please list:

School name _________________________ School phone number________________

Hours in school____________ a.m./p.m. to ______________________a.m./p.m.

Additional information which may be helpful in understanding your child, his or her

______________________________________________________________________

Food

Meals will be: _____ Prepared by the provider _____ Brought by family

Meals served will be: _____ Breakfast ____ Morning snack ____ Lunch

______________________________________________________________________

______________________________________________________________________

Infants will be fed according to family’s instructions. Please update and notify me of any

changes in feeding schedules, formulas and additional foods. Breast-fed infants need to

have an adequate supply of expressed milk in labeled bottles.

Illness

Please notify me if your child will be absent because of illness. If your child is home for

more than _____ days she/he must bring a signed physician’s statement when returning

to the program.

Please inform me of any contagious disease immediately. All families of children in my

care will be notified.

If your child becomes ill during care, you will be asked to pick up your child within _____