Infant Toddler Slots Non-Payment Contract

Infant Toddler Slots Non-Payment Contract

The Learning Center
Name of Child:
Date of Enrollment:

Month Day Year
Date
Agreement: $ 0 per/week
Fee Agreement:
per/week
Other Children enrolled:
- Childcare may not exceed 10 hours per day.
- Childcare may not exceed 10 hours per day.
- Every child must be signed into their classroom by 9:30 am. Your child will not be accepted into the
- Every child must be signed into their classroom by 9:30 am. Your child will not be accepted into the
classroom after 9:30am unless you have a doctor’s note. The Director can make exceptions in classroom after 9:30am unless you have a doctor’s note. The Director can make exceptions in extreme cases. extreme cases.
- Late Fees: $1.00 per every minute past 6:00 pm per child. After 6:15 the rate doubles to $2.00 per
- Late Fees: $1.00 per every minute past 6:00 pm per child. After 6:15 the rate doubles to $2.00 per
every minute. If it reaches 7:00 and we have been unable to contact anyone on your child’s every minute. If it reaches 7:00 and we have been unable to contact anyone on your child’s Emergency Card, we will need to contact the local police to help find the parent or a family Emergency Card, we will need to contact the local police to help find the parent or a family member. member.
- After SIX (6) documented late pick-ups or arrivals, you will be dismissed from the program (two
40 days in a year or your participation in the program may be redetermined. 40 days in a year or your participation in the program may be redetermined.
PROGRAM INCLUDES:
- Developmentally appropriate and individualized child care.
- Meals (***infant formula, juices and foods must be documented on Infant CACFP Enrollment Form as to
whether the parent or center will provide these items We provide breakfast, lunch, and a PM snack.
Child’s Weekly Schedule Child’s Weekly Schedule
No more than 10 hours No more than 10 hours
Monday Monday
Tuesday Tuesday
Wednesday Wednesday
Thursday Thursday
Friday Friday
Notes Notes
Child’s Arrival Time Child’s Arrival Time in class in class Child’s Departure Child’s Departure Time from class Time from class
M M
M M
Your child’sschedule(above)determines how we schedule our teachers Your child’s schedule (above) determines how we schedule our teachers. If it changes, we need tknow ASAP If it changes, we need to know ASAP.
NR ONR
NDIN NDINS
1. I agree to pay for child care services after 6:00pm, $1 per minute and doubles after 1. I agree to pay for child care services after 6:00pm, $1 per minute and doubles after

6:15pm. If I am past due on my account on the Monday of the week of car, e child care 6:15pm. If I am past due on my account on the Monday of the week of car, e child care

services will be interrupted for my child until payment is made. services will be interrupted for my child until payment is made.
2. The Learning Center will be closed the following Holidays: 2. The Learning Center will be closed the following Holidays:
New Year’s Day New Year’s Day Martin Luther King Jr. Holiday Fourth of July Martin Luther King Jr. Holiday Fourth of July President’s HolidayLabor Day President’s HolidayLabor Day Columbus Day Columbus Day Additional closed days (such as in-service days) with one month’s notice from The Additional closed days (such as in-service days) with one month’s notice from The Learning Center. Learning Center.
Memorial Day Memorial Day
Thanksgiving Day & Day After Thanksgiving Day & Day After Christmas Eve Christmas Eve Christmas Day Christmas Day
3. I understand that I must give two week’s written notice prior to withdrawing my child from 3. I understand that I must give two week’s written notice prior to withdrawing my child from

4. I agree to give a one week written notice for a requested vacation week. 4. I agree to give a one week written notice for a requested vacation week. 5. I will provide a doctor’s note for more than 2 consecutive absences. 5. I will provide a doctor’s note for more than 2 consecutive absences. 6. Absences should not exceed 40 days in a year in collaboration with the CCW program. 6. Absences should not exceed 40 days in a year in collaboration with the CCW program.
I, the parent / guardian I, the parent / guardian

Agree to the conditions of this contract. Agree to the conditions of this contract. Received complete written program information at the time of enrollment. (DHS regulation 3207.121b) Received complete written program information at the time of enrollment. (DHS regulation 3207.121b) Agree to update the emergency contact / parental consent form information whenever changes occur or Agree to update the emergency contact / parental consent form information whenever changes occur or
every 6 months at a minimum. (DHS regulation 3270.124f) every 6 months at a minimum. (DHS regulation 3270.124f)
Parent/Guardian Signature Parent/Guardian Signature
Provider Signature Provider Signature
Parent/Guardian Signature

Clear
Provider Signature

Clear
Date Date
Date Date
Date

Month Day Year
Date
Date of Child’s Admission: Date of Child’s Admission:
Date of Child's Admission:

Month Day Year
Date
Date of Withdraw:: Date of Withdraw
Date of Withdraw:

Month Day Year
Date
Third Street Alliance for Women & Children Third Street Alliance for Women & Children 41 N. Third Street Easton, PA 18042 41 N. Third Street Easton, PA 18042 610-258-6271 610-258-6271 610-258-2112 fax 610-258-2112 fax www.thirdstreetalliance.org www.thirdstreetalliance.org
Should be Empty:

Infant Toddler Slots Non-Payment Contract

PROGRAM INCLUDES:

Child’s Weekly Schedule Child’s Weekly Schedule

Monday Monday

Tuesday Tuesday

Wednesday Wednesday

Thursday Thursday

Friday Friday

Notes Notes

M M

M M

NR ONR

NDIN NDINS

Memorial Day Memorial Day

Thanksgiving Day & Day After Thanksgiving Day & Day After Christmas Eve Christmas Eve Christmas Day Christmas Day

Parent/Guardian Signature Parent/Guardian Signature

Provider Signature Provider Signature

Date Date

Date Date

Date of Child’s Admission: Date of Child’s Admission:

Date of Withdraw:: Date of Withdraw