Drop off Form

Drop Off Authorization Form

Little Me with Daycare/Preschool LLC
Parent/Provider Contract
1 Child’s name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Allergies / Medical / Mental conditions *

Daycare Schedule for Child 1*

	Date	Time In	Time Out
Monday
Tuestday
Wednesday
Thursday
Friday

2 Child’s name

First NameLast Name
Date of birth

MonthDayYear
Date
Allergies / Medical / Mental conditions

Daycare Schedule for Child 1

	Date	Time In	Time Out
Monday
Tuestday
Wednesday
Thursday
Friday

PARENT INFORMATION
Mother's First and Last name
Mother's phone number
Mother's address
Mother's work address and phone number
Mother's email
example@example.com
Father's First and Last name
Father's phone number
Father's Address
Father's work address and phone number
Father's email
example@example.com

EMERGENCY CONTACTS/PICK UP LIST:

Please list below the persons authorized to pick up your child in the event of an emergency or when you cannot get here on time:
First and Last name
Relationship
Phone numbers
Please list below anyone who is not allowed to pick up a child. In the event that you wish to list the other parent, PLEASE make sure that I have legal documents to prevent them from doing so, otherwise I can not stop them from taking his/her child from daycare.
Date

MonthDayYear
Date

Attention!

Drop off is non-refundable" means that once you drop deposit or payment, you will not be able to get that money back under any circumstances, even if you change your mind or cancel later on; essentially, it is a non-returnable payment. Because we save spot for that date for your children(s)

To save spot for Drop off please make a paymant at least 12 hour before when you bring your child.

8 hours or less $65 per day

after 8 hours $85 per day

In addtion, 10 am is the latest we can receive a kid in our daycare for dropp off.

Late Pick-Up Fees: If a child is picked up after agreed upon time, a fee of $1 per minute per child will be assessed.
Signature*

Clear
Date*

MonthDayYear
Date

How did you hear about us
WE APPRECIATE YOUR BUSINESS.

THANK YOU FOR CHOOSING

LITTLE ME WITH DAYCARE AS YOUR CHILDCARE.
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