Employee Childcare Agreement

EMPLOYEE CHILDCARE AGREEMENT

This Employee Childcare Agreement (the Agreement) is made between Employer Name: and Employee Name: (collectively, the Parties). Effective Date: .

Personal Information

Position Information

Employment History (Most Recent)

Education

References (Professional)

Childcare Participant Details

Schedule and Care Details

Regular Days of Care: Mon Tue Wed Thu Fri

Fees, Payment and Payroll Authorization

Regular Fee per child: $. Payment Frequency: .

Employer Subsidy (if any): . Late pickup fee: $ per 15 minutes. Returned payment fee: $.

Attendance, Absences and Withdrawal

Employee must notify the childcare program at least hours in advance of absences. Failure to provide notice or repeated unattended reservations may result in suspension or termination of childcare services. Withdrawal requires days written notice.

Health, Medication and Emergency Care

Employee affirms that the information provided concerning the child's health and immunization status is complete and accurate. If medication is to be administered, the employee must provide written instructions and medication in original pharmacy-labeled container. Permission to administer over-the-counter medication: Yes No

Authorization for Emergency Medical Treatment: In the event of an emergency, I authorize the childcare staff to obtain emergency medical care for my child and to transport my child to a medical facility if necessary. Child's preferred hospital or facility:

Pickup Authorization

Authorized to pick up child:

Confidentiality, Photography and Data Use

I consent to allow program staff to photograph or video my child for program records and internal educational use: Yes No

Liability, Indemnification and Insurance

The Employer will exercise reasonable care in the operation of the childcare program. To the maximum extent permitted by law, Employee agrees to indemnify and hold Employer harmless from claims arising from Employee's failure to disclose material health, custodial or safety information. Nothing in this Agreement waives liability for gross negligence or willful misconduct by the Employer.

Background Checks and Consent

Employee hereby authorizes Employer to obtain and review background checks, criminal history, and relevant records as needed to administer the childcare program and to ensure the safety of children in care. Employee acknowledges that approval to participate in the program may be conditional upon satisfactory results. Consent to background check: Yes No

Termination and Amendment

Employer reserves the right to suspend or terminate childcare services immediately for health or safety reasons, nonpayment, falsification of records, or violation of program policies. This Agreement may be amended in writing signed by both Parties.

Legal Disclosures

At-Will Employment: Nothing in this Agreement modifies the at-will nature of the Employee's employment, unless a separate written employment agreement states otherwise in a signed writing. Equal Opportunity: Employer is an equal opportunity provider. Participation in the childcare program will not be conditioned on protected characteristics and will follow applicable nondiscrimination requirements.

Employee Certification and Authorization

I certify that all information provided in this Agreement and accompanying documents is true, complete, and accurate to the best of my knowledge. I authorize Employer and its agents to contact references, prior childcare providers, and healthcare providers for verification and to obtain any records necessary to administer care. I understand that providing false information is grounds for denial or termination of childcare services.

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