Emergency contact person #1 First Name * Last Name * Phone number #1 * Relationship to the child * Emergency Contact person #2 First Name * Last Name * Phone number #2 * Relationship to the child * Authorized pick up person name/ relationship to child First Name * Last Name * Authorized pick up person name/relationship to child First Name * Last Name *
Please initial next to the following. I understand that I will be charged a late fee of $1.00/minute for each minute that I am late and arrive after 5:45 pm to pick up my child. Signature * I understand I will be charged $10 if I neglect to notify the director, at least one hour prior to dismissal, when my child will be absent on their scheduled day. Signature * Any changes to my child's schedule contract will be made two weeks in advance by notifying the Program Director in writing and subject to a $10 fee. Signature * My signatures signifies a promise to pay the appropriate monthly amount on a timely basis. Payments are due the before the 5th business day of the each month. After the 5th day a $1/day late fee may be applied to my account. Signature *