Child Care Form

CHILD CARE AGREEMENT AND AUTHORIZATION

This Child Care Agreement is made between Provider Name: and Parent/Guardian Name: .

WHEREAS

WHEREAS Provider operates a child care program offering caregiving, supervision, educational activities, and related services; and

WHEREAS Parent/Guardian seeks child care services for the child identified below and agrees to comply with the terms, fees, and policies set forth in this Agreement; and

WHEREAS the parties desire to set forth their mutual obligations, scope of services, payment arrangements, and legal terms in writing.

CHILD INFORMATION

EMERGENCY CONTACTS & AUTHORIZED PICK-UP

MEDICAL & HEALTH INFORMATION

Immunizations current: Yes No

SCOPE OF CARE

Provider will furnish routine daily care, supervision, meals/snacks as agreed, age-appropriate activities, and transportation for scheduled excursions if authorized. Provider will not provide medical or specialized therapeutic services except as expressly authorized in writing.

SCHEDULE

Regular days of care: Hours: From to .

PAYMENT TERMS

Fee per week or per month: . Payment schedule: . Payments are due in advance on the first scheduled day of care unless otherwise agreed in writing.

Late payment fee: A late fee of applies for payments received more than day(s) after the due date. Returned payment fee: .

TERM AND TERMINATION

Service Start Date: . Service End Date (if applicable): .

Either party may terminate this Agreement for any reason by providing written notice to the other party at least day(s) prior to the intended termination date. Provider may immediately suspend services for serious breach of health or safety policies or nonpayment.

PERMISSIONS AND AUTHORIZATIONS

Parent/Guardian authorizes Provider to obtain emergency medical care for child if necessary and to transport child to medical facilities as needed. Parent/Guardian will be responsible for all medical expenses not covered by insurance.

Permission to administer non-prescription medication (per label): Yes No

Permission for supervised outdoor activities and neighborhood walks: Yes No

Permission to use sunscreen provided by Parent/Guardian: Yes No

CONFIDENTIALITY

Provider and Parent/Guardian acknowledge that confidential information may be exchanged in connection with the care of the child. Each party agrees not to disclose personal, health, or proprietary information about the child or the other party except as required by law or as necessary to obtain emergency medical care.

LIABILITY, INDEMNITY & SAFETY

Provider will exercise reasonable care and supervision consistent with applicable standards. Parent/Guardian releases Provider from liability for ordinary negligence and agrees to indemnify and hold Provider harmless from claims arising from Parent/Guardian's negligence or failure to disclose material information. This release does not apply to willful misconduct or gross negligence.

GOVERNING LAW

This Agreement will be governed by and construed in accordance with the laws of the state in which the Provider conducts child care services, without regard to conflict of law principles.

ENTIRE AGREEMENT

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written statements, agreements, or understandings. Any amendment must be in writing and signed by both parties.

NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered personally or sent to the contact information provided by each party. Notices will be deemed given when received.

SIGNATURES

By signing below, Parent/Guardian and Provider certify that the information provided in this Agreement is true and complete to the best of their knowledge, that they have authority to enter into this Agreement, and that they accept and will comply with the terms set forth herein.

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