Child Parent Provider Care Contract Form – Fill Out and Use This PDF

PARENT-PROVIDER CHILD CARE CONTRACT

I.The following contract is between _____________________________________________________________________

(Parents of child(ren) in care)

and _______________________________________ located at ____________________________________________ for the

(Child Care Provider)	(Address of child care facility)
children listed below:
Child's Name_________________________	Date of Birth ____________________
Child's Name_________________________	Date of Birth ____________________
Child's Name_________________________	Date of Birth ____________________
Child's Name_________________________	Date of Birth ____________________

II.Standard Rates and Payment Policies:

1.A deposit of $_____________ is required. The deposit will be applied to the last week’s payment or to the termination notice period if proper notice is not given (see V. Termination procedure).

2. The fee will be $__________ per hour per dayper week (circle one)

Days and hours of care provided will be: ____________________________________________________________

3.Payment is to be given: ฀ weekly ฀ bi-weekly ฀ other ________________ on _________________________

(Day of week/month)

4.The child care provider will provide (check all that apply):

฀ Breakfast

฀ Morning Snack

฀ Lunch

฀ Afternoon Snack

฀ Dinner

5.The parent(s)/guardian(s) will provide the following (check all that apply):

฀ Change of Clothes ฀ Formula/Breast Milk ฀ Diapers & Wipes ฀ Infant Food

Provider will supply ______________________________________________ for an additional fee of $____________.

Other special arrangements include _________________________________________________________________

_____________________________________________________________________________________________

III.Rates for holidays, absences, vacations, overtime:

1.Care will not be provided, but payment is due, on the following holidays when they occur on a day the child(ren) is/are

regularly scheduled for care:	________________________	_________________________
	________________________	_________________________
	________________________	_________________________
	________________________	_________________________
	________________________	_________________________

2.The provider will be notified by ___________ if the child(ren) will be absent for the day.

(time)

3.Policy for payment of absences is: __________________________________________________________________

4.Fees and policies for provider’s vacation: ___________________________________________________________

5.Fees and policies for parent/guardian’s vacation: ______________________________________________________

6.If the provider is unable to provide care because of illness or emergency, the policy is:__________________________

_____________________________________________________________________________________________

7.If the parent/guardian drops off the child earlier or picks up later than the times specified above, the following overtime rate will be charged: $____________ per ____________ or portion thereof.

IV. Damages:

The policy on damage caused by the child(ren) while in the provider's care unless caused by the negligence of the provider is:

_________________________________________________________________________________________________

(This does not apply to normal wear and tear on toys or furniture, only to damage.)

V.Termination procedure:

This contract begins on the following date: _______________ and may be terminated by either parent/guardian or provider by giving

______ weeks' written notice. The provider may terminate the contract without notice if the parent/guardian is over

_______ week(s) late with scheduled payments. Parent/guardian may terminate the contract without notice if the provider does not comply with NYS child care regulations/laws. Changes to the contract, desired by either provider or parent/guardian, must be made in writing and acknowledged in writing by the other parties at least 2 weeks before the desired change takes effect. A new contract may be signed at that time to reflect the changes.

VI. Signatures:

By signing this contract, all parties agree to all of the above terms and policies, including financial responsibility for child care provided. The provider is responsible for providing all parties a copy of the signed contract.

___________________________________________________________	__________________________
Provider's signature	Date
___________________________________________________________	__________________________
Mother/Legal guardian signature	Date
___________________________________________________________	__________________________
Address of Mother/Legal guardian	Phone number
___________________________________________________________	__________________________
Father/Legal guardian signature	Date
___________________________________________________________	__________________________
Address of Father/Legal guardian	Phone number
___________________________________________________________	__________________________
Co-signer's signature (Required if parent/legal guardian is under 18	Date
years old. Co-signer must be 18 or older and by signing assumes
financial responsibility in case the parent/guardian fails to pay for care provided.)

Developed by Child Development Council

Last Revised 5/2009