Drop In Form

Drop In 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 2 (If the same please skip schedule)

	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-In Policy

Please note that Drop-In payments are non-refundable. This means that once you make a payment or deposit, it cannot be returned under any circumstances, even if you cancel or change your plans. We reserve a spot for your child on the requested date, which is why this policy is strictly enforced.

To reserve a Drop-In spot, payment must be made at least one day in advance of your child’s attendance.

Important Reminders:

Latest drop-off time for Drop-In care is 10:00 AM. We cannot accept children after this time.

Late Pick-Up Fee: A fee of $2.00 per minute per child will be charged if your child is picked up after the agreed-upon pick-up time.

Thank you for understanding and helping us maintain a smooth and organized daycare environment.
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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