Child Care Financial Agreement
This child care financial Agreement is made this ______ day of ______________, 2011,
by and among _____________________________, residing at ____________________
Parents Parents’ Address
_____________________ and ______________________, residing at ______________
Provider Provider’s Address
____________________. This agreement is for the care of ______________________,
_______________________, residing at _____________________________________,
Date of Birth Child’s Address
WHEREAS, Provider is a duly licensed Family Day Care Provider under the Code of
WHEREAS, Provider is a self-employed individual and desires to provide family day care
services for Child in her own home in a safe and nurturing environment;
WHEREAS, the Parties desire to set forth their respective rights and obligation to each
THEREFORE, the Parties agree as follows:
1. VIRGINIA FAMILY DAY CARE SYSTEM REGULATIONS
Provider agrees to comply with the DAY CARE STANDARDS.
2. PROVIDER’S RIGHTS AND RESPONSIBILITIES
a. Provider will provide child care services in her own home for Child in
accordance with the DAY CARE STANDARDS and
with this Agreement.
b. Provider will provide child care services for Child beginning on
___________________________ according to the following
Arrival Time Departure Time
Monday __________ __________
Tuesday __________ __________
Wednesday __________ __________
Thursday __________ __________
Friday __________ __________
Provider and Parent may agree to modify this schedule by mutual
c. Provider is responsible for planning Child’s daily activities. Provider
will follow Parent’s wishes, as expressed in the Authorization
Agreement form, concerning Child’s participation in field trips and
d. If Provider is ill or otherwise unable to provide child care services for
Child on a particular day, Provider will make every attempt to
arrange for replacement services to be performed by a substitute, who
will comply with the DAY CARE STANDARDS and the other Provider
performance requirements in this Agreement.
e. Provider will be available for parent conferences to discuss Child’s
progress, Parent’s child care needs and any other issues of concern to
f. Provider will release Child only to Parent or to
_______________________________________, as designated by
3. PARENTS’ RIGHTS AND RESPONSIBILITIES
a. Transportation to and from Family Day Care Home will be provided
by Parent. Parent will escort Child to and from Provider’s home and
will leave Child only with Provider or, if applicable, with the
Provider’s substitute designated pursuant to Section 2(d).
b. Prior to the Commencement Date, Parent will complete and provide
Provider with a Parent/Guardian Authorization Agreement form,
granting or denying permission for Child to participate in field trips
and water activities.
c. Prior to the Commencement Date, Parent will complete and provide
Provider with an Emergency and Medical Authorization Form, which
shall contain the name, address, and telephone number of Child’s
physician and instructions for emergency medical treatment.
d. Prior to the Commencement Date, Parent will provide Provider with a
written statement explaining any of their child’s special requirements,
child care needs or any other referral information as contained on the
Developmental History form.
e. Prior to the first day in care, Parent will provide Provider with an
immunization record and physical exam signed by a physician.
Provider will notify Parent when these records need to be updated.
f. Prior to the first day of care, Parent will provide Provider with the
Child’s proof of identity as required by Virginia state law.
4. FINANCIAL AGREEMENT
a. Parent will directly compensate Provider for provider services
hereunder by paying the sum of:
________________________________ dollars ($________) upon the
execution of this agreement and $____________ monthly thereafter.
Monthly payment will be due on the _________ day of each month.
b. Parent agrees to pay a late fee of $5.00 per 15 minute interval if
arriving before scheduled arrival time or after scheduled departure
time. (i.e.: $5.00 for 1 – 15 minutes late; $10 for 16 – 30 minutes late,
etc.) Late fees will be billed by invoice on the first day of the week
following the late arrival(s) or departure(s).
c. Parent agrees to pay a late fee of $25.00 if monthly payment is made
more than three (3) business days after the due date stipulated in
Section 4(a.) Additionally, Parent agrees to pay a $25.00 returned
check fee for all payments returned for insufficient funds or any other
reason. Late and returned check fees will be billed by invoice on the
first day of the week following the occurrence.
d. Parent will be financially responsible for all time Provider is
scheduled to provide child care services to Child and Parent
understands that there will be no reimbursements if Child is unable to
come to Provider’s home due to Child’s illness, vacation, or any other
cause. If Child is scheduled to attend on a part-time basis, neither
holidays nor any other days are transferable to a day when Child does
not regularly attend.
e. All holidays, as listed in the Annual List of Holidays provided to
Parents, shall be payable, with the exception of holidays which fall on
days when the Child is not regularly scheduled to attend.
f. Provider will advise Parents in advance (not less than 2 months) of
three (3) weeks per year during which the business will be closed. The
first two (2) of these weeks shall be payable to the Provider. The
remaining week will not be payable to the Provider.
g. It is anticipated and agreed to by the Parties that the amount to be
paid by the Parent may be adjusted on an annual basis with such
adjustment becoming effective in the month of commencement of
services each year.
5. TERM OF AGREEMENT
The term of contract is for one (1) year, and may be renewed for an additional
period of one (1) year by mutual agreement of the Parties.
Each of the Parties may terminate this Agreement upon two (2) weeks written
notice to the other Party or upon mutual agreement of Parent and Provider.
Any clause of this Agreement which does not comply with the DAY CARE
STANDARDS, or is found otherwise unenforceable, shall be severed. The Parties
agree to comply with the remaining provisions of the Agreement.
As used in this Agreement:
a. Feminine pronouns or other terms shall include both the feminine and
b. Singular terms shall include both the singular and the plural. Plural
terms shall include both the plural and the singular;
c. “Parent” shall refer to the parent or guardian;
d. “And” means “and/or;”
e. “Or” means “and/or;”
f. “Each” means “any and all.”
Provider’s Signature Date
Mother’s Signature Date
Home Address Phone Number
E-mail Alt. Phone Number
Father’s Signature Date
Home Address Phone Number
E-mail Alt. Phone Number