The contracted hours of care for ___________________________ (child/ren) in the home of Sheri Knott are between the hours of _______ (a.m./p.m.) and _______ (a.m./p.m.) for _______ days of the week, on the following days of the week ____________________.
The basic charge shall be $_______ per ____________, and shall be paid each Friday by check, cash, or money order. A penalty charge of $25 will be assessed for each check returned. In addition, the parent will pay for all expenses to the provider's account resulting from the returned check. In the event of a second returned check, payment for a period of six months must be made in cash only or the provider may choose to terminate service. The provider reserves the right to adjust the fees at any time with at least two weeks notice.
I/We ___________________________ have read this agreement and the policies and will comply to all provisions contained therein, and shall at this time enter into agreement with Sheri Knott for the care of my/our child, ____________________, with the understanding that we shall work together on the behalf of the child.
This agreement is in effect until a change is mutually agreed upon in writing or upon termination of care.
This agreement is subject to review and renewal on _______________. Any changes made by the provider to the terms of the agreement must be made on the renewal date unless mutually agreed to beforehand by the provider and parents who are parties to this agreement. Otherwise, this agreement will remain in effect until the renewal date or upon termination of care as set forth herein.
SIGNED (Parent or Guardian) ____________________ SSN __________ DATE ______
I, Sheri Knott, have discussed and reviewed this agreement with ______________________________ and agree to provide child care for ____________________ to be placed in my home on as long as the terms of the agreement are upheld.
SIGNED (Provider) _______________ SSN __________ DATE _____
DATE CHILD WITHDRAWN FROM CARE _______________.