Child Care Agreement between Family Child Care Provider and Parent
This is an agreement between______________________, parent(s) and
________________________________family day care provider, regarding the care of the
1. Birth Date
2. Birth Date
3. Birth Date
I agree to provide child care for your child(ren) while you work, during the hours of:
______ to _______ and on the following days of the week:
You agree to pick up your child(ren) on time. An additional fee of $_____ per _____ will be
charged if you are late. In the event of an emergency, you agree to notify me as soon as
possible and let me know what time you will arrive.
You will sign a form prior to your child’s first day of care indicating any individuals who are
authorized to pick up your child(ren). You will agree to notify me prior to any day one of these
individuals (other than yourself) will pick up the child.
The fee for care will be:
Hourly $________ Daily $_______ Weekly $_______ Other $_______
This fee includes:__________________________________________
but not diapers, wipes, or ___________________________________
You agree to pay this fee in full on ___________________ ; which will be for care for the next
We will agree on overtime hours in advance with an overtime fee of $_____ per hour.
Fees may be renegotiated on or before ________________ and any changes will be effective
on the following _______________ of that same calendar year.
I will be paid for the following holidays: New Year’s Day, Memorial Day, July 4th, Labor Day,
Thanksgiving Day, Christmas Day and ___________________. I will not be providing care on
the following personal or religious days _________________________________; you will/will
not be charged for these days.
I understand that you will observe the following personal or religious days
_________________________________________________. You will/will not be charged for
I will take _______________________ days of vacation per year; I will let you know at least
one month in advance and you will not be charged for this time.
When your child is sick, you should notify me by ____________in the morning, or the night
before if possible.
When your child becomes ill in my home, I will notify you as soon as possible to discuss
treatment and/or early or immediate pick up. Your child must be picked up within an hour
whenever possible, unless a mutually agreed upon time is set. You agree to accept and trust
my judgment of how sick your child has become while in my care. I am/am not certified to
administer medication to children in my care.
If your child is seen by a doctor for an illness, he/she must return with a note from that doctor
indicating the type of illness, expected term of illness, medication child is on, and if illness is
contagious. If your child begins taking an antibiotic, he/she must stay home for at least 36
hours after the medication has been started.
As part of this contract, you agree to sign a medical information and permission form for your
child(ren) and I will keep the form(s) accessible.
I agree to offer an atmosphere of warmth, caring and concern for all the children in my care. I
will offer nutritious snacks, meals, and beverages for every child. I will take responsibility for
strollers, clothing or other items belonging to the child.
You will agree to provide me with all the necessary forms and telephone numbers where you
or a responsible relative can be reached at all times before the first day your child(ren) is in
A trial period of care is an option if we both agree; this period will continue until
This agreement is effective as of _______________________. The child’s first day will be