Leary Family Child Care

PARENT/CAREGIVER CHILD CARE CONTRACT

Name of Child(ren) ____________________________________________________

Father's/Guardian's Name _____________________________________________

Father's/Guardian's Social Security Number _____________________________

Father's/Guardian's Driver's License Number ___________________________

Mother's/Guardian's Name _____________________________________________

Mother's/Guardian's Social Security Number ___________________________

Mother's/Guardian's Driver's License Number ___________________________

We agree to pay Laura Leary $ ____________ per month/week/day for care of our child(ren) and a

fee of $5.00 for every day the payment is late past the day/week/month it is accrued.

Care for the above named child(ren) will normally begin at ______ o'clock and end at __________ o'clock on the following days of the week:

________________________________________________________________________

Payment will be made in the following manner: cash _______ check ______ on

___________________________________________ (day of month or week) by

_____________________________ (name of person to pay).

Child care services will begin on ________________________________ (date).

Care for the above child will include the following meals and snacks:

________________________________________________________________________

Only parents or persons with written authorization from parents shall be allowed to take any child from the facility except that verbal authorization may be used in emergency situations. Verbal identifi

cation parent will give: ________________________________________________________ (Optional)

We, the parents/guardians of the above named child(ren) have read the policies and procedures in the Leary Family Child Care Parent Handbook and do consent to abide by this agreement and the policies as explained.

Mother's/Guardian's Signature _________________________________________

Father's/Guardian's Signature __________________________________________

Caregiver's Signature __________________________________________________

Date Signed ___________________________________________________________