Are electronic signatures legally valid?

Yes. Under the federal ESIGN Act and state UETA laws, electronic signatures are generally valid for contracts and enrollment forms unless a specific statutory exception applies.

When is notarization or a witness required?

Notarization or witness requirements depend on state law and the document’s legal effect; most routine enrollment statements do not require notarization but some states or program agreements may.

Can I correct mistakes after signing?

Minor corrections typically require an amendment signed by both parties. For substantive changes, create a new statement or an addendum and obtain fresh signatures to avoid disputes.

Who must sign the statement?

At minimum, an authorized provider representative and the child’s parent or legal guardian should sign. If a third-party payer or agency is involved, their signature or acknowledgment may also be necessary.

How should I store signed statements?

Store signed copies securely with access controls. Maintain originals or certified digital records with audit trails for the recommended retention period in case of licensing review or claims.

Are health details covered by HIPAA?

If the provider is a HIPAA-covered entity or business associate, health information in the statement is subject to HIPAA; otherwise, state privacy laws or program rules may apply.

Electronic Signature
Templates
Miscellaneous
Child Care Service Statement

Child Care Service Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

CHILD CARE SERVICE STATEMENT

Recitals

WHEREAS, Provider Name: is engaged in the business of providing child care services; and

WHEREAS, Parent/Guardian Name: (hereinafter "Guardian") seeks child care services for the child identified below under the terms and conditions set forth in this Statement; and

WHEREAS, the parties intend that this Child Care Service Statement (the "Statement") set forth the scope, payment terms, confidentiality and other material provisions governing the services to be provided by Provider to Guardian.

Parties and Child Information

Provider Legal Name Provider Address Provider Phone Parent/Guardian Name Parent/Guardian Address Parent/Guardian Phone Child Full Name

Child Date of Birth: Sex:

Allergies, Medical Conditions, Special Needs

Scope of Services

Provider shall provide child care services including supervision, feeding, diapering/toileting assistance, rest periods, age-appropriate activities and transportation only as expressly authorized below. Services will be provided at the following location:

Detailed Scope (days, hours, activities, exclusions)

Regular Days of Care: Regular Hours: From To

Payment Terms

Service Fee (per child) Payment Schedule

Late Payment Penalty: . Guardian is responsible for all costs of collection, including reasonable attorney fees.

Additional Charges (meals, supplies, transportation)

Health, Medication and Transportation

Provider authorized to administer non-prescription medication: Provider authorized to administer prescription medication per written instruction:

Medication Instructions / Consent (if applicable)

Provider authorized to transport child for activities or emergencies: . If checked, describe limitations:

Term and Termination

Term Commencement Date: Term End Date (if any):

Either party may terminate this Statement for any reason upon written notice to the other party delivered at least days prior to the intended termination date. Provider may terminate immediately for nonpayment or for known risks to child safety.

Confidentiality

All personal, medical and developmental information concerning the Child and Guardian provided to Provider in connection with services under this Statement is confidential. Provider shall not disclose such information except (i) as required by law, regulation or court order, (ii) to emergency medical personnel when necessary for the Child's care, or (iii) with prior written consent of Guardian. Provider shall take commercially reasonable measures to safeguard written and electronic records.

Liability, Indemnification and Insurance

Provider will maintain general liability insurance coverage customary for child care providers. Except for gross negligence or willful misconduct, Provider's liability for any claim arising out of this Statement shall be limited to direct damages not to exceed the total fees paid by Guardian for the three (3) months preceding the claim. Guardian shall indemnify, defend and hold Provider harmless from claims by third parties arising from Guardian's acts or omissions, including failure to disclose medical conditions or pick-up authorization.

Governing Law; Entire Agreement

This Statement shall be governed by and construed in accordance with the laws of the state identified as Governing State: , without regard to conflict of law principles.

This Statement, together with any written attachments executed by the parties, constitutes the entire agreement between Provider and Guardian with respect to the subject matter herein and supersedes all prior oral or written agreements. Any amendment must be in writing and signed by both parties.

Acknowledgments and Consents

Guardian acknowledges that they have provided accurate information about the Child and consents to the Scope of Services and terms set forth in this Statement. Guardian hereby grants Provider authorization to obtain emergency medical care for the Child if Guardian cannot be reached.

Emergency Contact #1 (Name and Phone) Emergency Contact #2 (Name and Phone)

Acknowledgment of Policies

Guardian acknowledges receipt of Provider's policies regarding sick child exclusion, emergency procedures, and pick-up authorization and agrees to comply with these policies. Guardian further acknowledges responsibility for timely payment as set forth above.

Provider Printed Name:

By:

Date:

Parent/Guardian Printed Name:

By:

Date:

What the Child Care Service Statement Is and When It’s Used

A Child Care Service Statement is a written record that describes the scope, schedule, fees, and responsibilities associated with child care services provided by a center, family child care home, or individual caregiver. It documents the parties (provider and parent/guardian), hours of care, authorized pick-up persons, emergency contacts, medical or allergy alerts, and payment terms. The document is used at enrollment, updated after material changes, and retained as part of the child’s administrative file for licensing, insurance, and regulatory compliance.

Why a Clear Service Statement Matters

A precise Child Care Service Statement reduces misunderstandings about schedules, fees, and responsibilities, supports licensing reviews, and creates a defensible record in disputes or emergencies. It clarifies expectations for families and staff while helping the provider meet regulatory and insurance requirements.

Who Typically Completes or Signs This Statement

Keep copies for both the provider and family; retain originals with the child’s file for regulatory or insurance review.

Licensed child care centers and directors sign to confirm program policies and hours of operation.
Family child care providers and in-home caregivers use it to document agreed services and emergency contacts.
Parents or legal guardians sign to acknowledge fees, authorization for medical care, and approved pick-up designees.

Core Elements to Include in a Professional Statement

A complete Child Care Service Statement combines administrative, health, scheduling, financial, and consent details so both parties understand expectations and obligations.

Parties

Full legal names for the provider, facility, and parent/guardian plus primary contact details and relationship to the child.

Service Hours

Specified days and hours of care, holiday closures, late pickup policy, and procedures for unscheduled closures or emergencies.

Fees & Payment

Detailed fee schedule, accepted payment methods, due dates, late fees, deposits, refund policy, and payment dispute process.

Health & Medication

Allergies, chronic conditions, required immunizations, medication administration instructions, and emergency medical authorization.

Authorized Pickup

List of persons authorized to pick up the child, required ID checks, and procedures for changes or temporary designees.

Consents & Notices

Photo release, field trip consent, transport authorization, and acknowledgment of policies such as behavior management and confidentiality.

Step-by-Step: Completing the Statement

Follow these steps to prepare, review, and store a valid Child Care Service Statement.

01

Gather documents: Collect ID, immunization records, and emergency contact details before starting.
02

Enter details: Fill all required fields accurately, using MM/DD/YYYY for dates.
03

Review terms: Verify fee schedule, late payment terms, and consent items with the parent.
04

Sign and record: Obtain required signatures and save a copy for both parties and the child’s file.

How an Online Workflow Typically Routes the Statement

Digital workflows streamline collection, review, and storage while preserving an audit trail.

Step	Responsible party \| Action
Initiate	Provider uploads form and pre-fills known fields
Parent Review	Parent receives secure link and verifies entries
Signatures	Parent and provider e-sign; witness or notarization added if required
Archive	Signed copy stored in the administrative file with audit trail

Digital Delivery and Technical Requirements

Ensure the chosen provider meets any regulatory privacy or access needs and can export signed records in standard formats.

File types: PDF and DOCX are widely supported and preserve layout and fields.
Authentication: Email link plus optional SMS or knowledge-based authentication improves signer attribution.
Integrations: Connect to cloud storage or child care management systems for centralized archives.

Typical Digital Signing Flow for Providers and Families

This simplified sequence shows how a completed statement moves from draft to archived record.

Upload form: Provider uploads template to the signing platform
Place fields: Add name, date, signature, and conditional fields as needed
Send link: Generate a secure signing link or email invitation
Complete & store: Signer completes form; signed copy saved with audit trail

Timing Considerations and Common Deadlines

Track enrollment, update, and review deadlines to remain compliant and maintain accurate records.

Initial Submission:

Provide the statement at or before the child's first day of care.

Change Updates:

Update the statement within 30 days of material changes to contact or health info.

Annual Review:

Perform at least one annual review and re-sign to confirm continued consent and accuracy.

Regulatory Access:

Produce records to licensing agencies upon request, typically within 7–30 days.

Parent Requests:

Respond to parental record access or correction requests within 30 days.

Key Milestones from Enrollment to Archival

Milestones show the document lifecycle from creation through retention and possible dispute resolution.

01

Drafting

Provider prepares statement and pre-fills known child details.

02

Parent Review

Parent reviews policies, fees, and consents; requests clarifications.

03

Execution

Signatures obtained and timestamped; witnesses or notarization added if required.

04

Storage

Signed statement archived with audit trail and access controls.

Common Mistakes to Avoid When Preparing the Statement

Leaving emergency contacts incomplete, which delays medical response in an incident.
Using ambiguous fee language like 'may charge' instead of exact dollar amounts and due dates.
Failing to update authorized pickup lists after changes, increasing security and liability risk.
Not retaining a signed copy for every child, which complicates regulatory inspections and claims.

Potential Risks and Consequences of Errors

Regulatory Noncompliance: Fines or corrective actions from state licensing bodies for missing or inaccurate records.

Liability Exposure: Inadequate consents can increase legal exposure if a child is injured or medically treated.

Insurance Denial: Incorrect documentation may lead insurers to deny claims for incidents.

Payment Disputes: Vague fee terms can cause collection problems and reputational harm.

Privacy Violations: Improper handling of health data may trigger HIPAA or state privacy concerns where applicable.

Operational Delay: Missing signatures or fields delay enrollment and access to services.

Comparison: eSignature Vendor Pricing and Key Capabilities

Basic pricing and capability differences for commonly considered eSignature vendors; signNow is listed first per standard comparisons.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions About Child Care Service Statements

Answers to common questions about validity, signatures, updates, and storage for Child Care Service Statements.

Need help? Contact support

Are electronic signatures legally valid?
Yes. Under the federal ESIGN Act and state UETA laws, electronic signatures are generally valid for contracts and enrollment forms unless a specific statutory exception applies.
When is notarization or a witness required?
Notarization or witness requirements depend on state law and the document’s legal effect; most routine enrollment statements do not require notarization but some states or program agreements may.
Can I correct mistakes after signing?
Minor corrections typically require an amendment signed by both parties. For substantive changes, create a new statement or an addendum and obtain fresh signatures to avoid disputes.
Who must sign the statement?
At minimum, an authorized provider representative and the child’s parent or legal guardian should sign. If a third-party payer or agency is involved, their signature or acknowledgment may also be necessary.
How should I store signed statements?
Store signed copies securely with access controls. Maintain originals or certified digital records with audit trails for the recommended retention period in case of licensing review or claims.
Are health details covered by HIPAA?
If the provider is a HIPAA-covered entity or business associate, health information in the statement is subject to HIPAA; otherwise, state privacy laws or program rules may apply.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now