EARLY LEARNING CENTER SCHEDULE AGREEMENT FORM
Date________ Student ID Number___________________
Category (check one): Student______ Staff/faculty_____ Community______
Semester (circle one): Fall ___ Spring___
Indicate schedule of days and times needed for child care by entering the exact time
you plan to leave and pick up your child. This schedule is used to determine the set
weekly fee you will be charged, regardless of child’s attendance.
IN OUT IN OUT TOTAL
My weekly fee for services is: $_____________________. (see fee schedule on back)
Name of individual(s) or agency responsible for payment (i.e. self, other third party,
Choices –with a valid certificate): ____________________________.
I understand this amount of payment is expected to be paid in full according to the
agreed upon payment schedule whether my child is in attendance or not. My payment
will be adjusted to reflect additional hours if more hours are used than scheduled.
(Parent/Legal Guardian Signature) (Date)
(Director or other authorized Children’s (Date)
Room Personnel Signature)
The following fee schedule is used to determine the weekly fee you will be cha rged.
Students Staff/Faculty Community
Up to 10 hours per week $40 $45 $50
10 hours – 20 hours per week $70 $75 $80
20 hours and over per week $90 $100 $110
Hourly $4.50 $5.50 n/a
Registration fee per semester $5 $5 $20