CY 321 - Day Care Agreement (1)

NAME OF CHILD
FEE AMOUNT
PER DAY WEEK
DAY PAYMENT TO BE MADE
SERVICES TO BE PROVIDED
CHILD'S ARRIVAL TIME
LATE FEE
CHILD'S DEPARTURE TIME
PER MIN HR
PERSONS) DESIGNATED BY PARENT TO WHOM CHILD MAY BE RELEASED
Extra services to be provided at an additional fee if applicable
received complete written program information at the time of enrollment. (S 3270.121, 3280.121 3290.121

received complete written program information at the time of enrollment. (S 3270.121, 3280.121 3290.121agree to update the emergency contact/parental consent form information whenever changes occur or every 6 months at a minumum. (S 3270.124, 3280.124, 3290.124)
SIGNATURE OF OPERATOR

Clear
SIGNATURE PARENT OR GUARDIAN

Clear
DATE

MonthDayYear
Date
DATE OF CHILD'S ADMISSION

MonthDayYear
Date