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Embed code for: H1 B Provider-Client Agreement
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Provider – Client Agreement for Child Care Services
This contract is made between:
_________________________________________________________ (child care provider) for child care services described below.
Child Care Services will be provided for:
1. Name of child: Date of birth:
2. Name of child: Date of birth:
3. Name of child: Date of birth:
4. Name of child: Date of birth: ______
Child care services will begin on ___________________________________ (insert day of week & date). Child care is open year-round, except for holidays, vacation, sick and professional growth days listed in the Parent Handbook.
The contracted days and hours of child care services are as follows:
Monday _____ AM/PM to _____ AM/PM
Tuesday _____ AM/PM to _____ AM/PM
Wednesday _____ AM/PM to _____ AM/PM
Thursday _____ AM/PM to _____ AM/PM
Friday _____ AM/PM to _____ AM/PM
Saturday _____ AM/PM to _____ AM/PM
Sunday _____ AM/PM to _____ AM/PM
Child Care Rate:
The charge for care is $ _____ per _______ (day/week/month), payable on ________________ (day of week or month) is required.
Payment is accepted by cash, check, money order or direct deposit. Payment is due regardless of attendance. The child care fee must be paid one week in advance and due no later than Friday before care begins the following week.
The client will pay a $ ____ per day fee for late child care payments. For tax purposes, a yearly statement, W-10 form will be provided to each family by January 15th.
Returned checks must be paid by cash. Additional returned checks will result in cash or direct payment only. There will be a $____________ (amount) returned check charge plus any additional charges incurred to myself and/or by the bank.
Outstanding accounts will be sent to court and collections; the client will be responsible for all court costs.
Fees due upon enrollment:
Non-refundable registration fee of $__________________________
Advance payment for last two weeks of care in the amount of
$ __________________________ (week/month), which will be credited towards the last _______ (# of weeks) of child care provided all provisions in this contract and the Parent Handbook are met.
Overtime charges will apply for hours of child care before _________ AM/________ PM and after _______AM/ _______PM.
Client will pay an additional fee of $__________________ per minute if the child is dropped off earlier or picked up later than the time stipulated by this contract.
If prior arrangements are made with the provider the overtime rate will be $______________________ per hour.
If the client is receiving state subsidized child care assistance, the co-pay will be $ ______________________ per month and responsible for paying the full amount of the fees under this contract if child care assistance payments are interrupted for any reason.
Due to cost of living increases, child care fees will increase annually at a rate of $ ____________________________ per (day/week/month).
Child care will include the following meals and snacks:
Breakfast PM Snack Lunch PM Snack Dinner
Release of Child:
Children may be taken from the provider’s care only by the person/s signed below and those named on the Authorization to Leave Care form.
A trial period of child care will begin on __________________ (insert date). The client will pay $ _______________________ per week. During this time, either the client or the provider may cancel the contract immediately, without written notice. If the contract is cancelled during this _________ (insert amount of time) trial period, the client will pay a prorated fee. Payment is due for each day unless the contract is cancelled before the day begins.
The Client may terminate this contract at any time with _____ (days/weeks) written and paid notice. The provider may provide _____ (days/weeks) written notice of termination but reserves the right to immediate termination if the client or child posses any threat to the safety and welfare of other children in care, the providers family or failure to comply with policies.
All parties agree to the contract terms and understand this is a legal binding agreement. By signing this contract, clients indicate that they have read the provider’s policies and agree to follow them. I reserve the right to make changes to my policies without notice. This contract is entered into by the client and provider and will remain in effect until termination of care or the signing of a new contract.
By signing this page, you indicate that you have received and read my policies and agree to follow them.
Parent or legal guardian’s signature Date of signature
Parent or legal guardian’s signature Date of signature
Co-signer’s signature Date of signature
A co-signer is required if the client is under the age of 18. The co-signer guarantees the contract and agrees to be responsible for all its financial terms if the client fails to pay the provider.
Provider’s signature Date of signature
Resource Provided by YMCA Childcare Resource Service
YMCA Childcare Resource Service. May be reproduced for personal use only., check, money order or direct deposit. Payment is due regardless of attendance. The child care fee must be paid one week in advance and due no later than Friday before care begins the following week.
The Client may terminate this contract at any time with _____ (days/weeks) written and paid notice. The provider may provide _____ (days/weeks) written notice of termination but reserves the righ