Child Care Enrollment Form

Child Care Enrollment Form:

Please complete the following form to register your child and provide necessary consent and information.
Lil'Cats Daycare

where learning is child's play

1609 S. Commercial Ave

325-625-1076

lilcatsdaycare@gmail.com

Monday - Friday

7:30 am - 5:30 pm

Total Weekly Price:	First Child	Second Child	Third & Fourth child
0 mths-17mths	185	175	165
18 mths and older	170	160	150
After School Care	60	60	60
Drop in Care	40	40	40

Lil'Cats Discounted rates below: Discuss with management on how to receive discount

Total Weekly Price:	First Child	Second Child	Third & Fourth Child
0 mths-17 mths	150	140	130
18 mths and older	130	120	110
After School Care:	60	60	60
Drop In Care:	40	40	40

$30 Enrollment Fee

Full payment is due for all the participating children in your family every Monday or the following business day if the Day Care is closed due to a holiday for the next week's service. The Day Care may exercise the right to decline the care of a child if their parent's account is not current. A $10 a day late charge per child will be added to any account not paid before Tuesday morning unless payment arrangements have been made. A late charge will be added to any payment arrangement not paid on agreed upon day. If you are late, a fee of $10 for the first five minutes and $1 for every minute following will be charged if you pick up your child after 5:30pm. Late penalties must be paid to Lil’ Cats Daycare before the child can return to care

Payments made are for the reservation of services only and will be forfeited if not used. Neither refunds nor credits are given under any circumstances. You must pay for the whole week. If your child is sick, you are still required to pay for the week. Special circumstances will be considered on a base by base situation. Final determination is reserved by Managment. If a check "bounces" for insufficient funds, an additional fee of $25 will be charged. Following the event of a "bounced" check future payments may be required to be made in cash or certified check. The Day Care is closed on Saturday and Sunday and on certain Federal Holidays.
Either party may terminate this contract at any time by supplying a written notice of termination on a specified date to the other party, with at least two week notice prior to the stated date of termination. If there is any litigation needed between the Client and Day Care it shall be filed and tried in the Day
Care's local jurisdiction. In agreement to the above mentioned terms the Client and a representative of the Day Care sign below: Applicable Law
This contract shall be governed by the laws of the State of Texas in Coleman County and any applicable Federal Law.
Child Information
Childs Full Name

First NameMiddle NameLast Name
Gender
Child's Social Security Number
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Information:
Mother/Guardian Name

First NameLast Name
Mother/ Guardian Email
example@example.com
Mother/Guardian Cellphone:
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Guardian Work Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father/Guardian Name

First NameLast Name
Father/ Guardian Email
example@example.com
Father/Guardian Cellphone:
Please enter a valid phone number.Format: (000) 000-0000.
Father/Guardian Work Phone:
Please enter a valid phone number.Format: (000) 000-0000.
If divorced/separated, Lil'Cats Daycare require parents to supply a copy of the Court Order. Failure to supply this information will result in immediate termination of care.
Who should be contacted in an emergency WHEN the parent cannot be reached?

First NamePhone Number
Who should be contacted in an emergency WHEN the parent cannot be reached?

First NamePhone Number
Who should be contacted in an emergency WHEN the parent cannot be reached?

First NamePhone Number
Authorized Pick-Up Person List all adults (18+) allowed to pick up your child from daycare.

First NamePhone Number
Authorized Pick-Up Person List all adults (18+) allowed to pick up your child from daycare.

First NamePhone Number
Authorized Pick-Up Person List all adults (18+) allowed to pick up your child from daycare.

First NamePhone Number
General Information
Admissions Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
My Child Attends the Following Public School:
Authorization of Emergency Medical Attention:
Consent Options
List any special problems that your child may have, such as allergies, existing illnesses, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of: If none, please type none in the box below
Health Statement
ADMISSION REQUIREMENT: If your child does not attend pre-kindergarten or school away from the child-care operation, one of the following must be presented when your child is admitted to the child-care operation or within one week of admission. Please check only one option:
Meals/ Nutrition
I understand that breakfast, lunch, and an afternoon snack will be provided
Sign Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Print Name

First NameLast Name
Parents Signature
Should be Empty:

Child Care Enrollment Form:

Child Information

Parent/ Guardian Information:

General Information

Authorization of Emergency Medical Attention:

Health Statement

Meals/ Nutrition