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Fee Payment Agreement


Child's Name:                                                                   Parent/Guardian's Name:                                                       




Name of person paying fee:                                                                                                    

Agreed arrival time:                                                                              Pick‑up time:

Days receiving care (Circle)          M        T        W       TH        F

A fee of _______________ per __________ is due and payable on _______ of each ________________________.


I understand that closing time is 6:00 pm. I also understand that I will pay $1.00 per child, per minute, after my pre‑designated pickup time that my child/children remain/s in child care. I will pay this fee at the time I pick‑up my child/children.


I agree to give at least two weeks written notice of termination of this agreement, withdrawal from care, or change in hours, days or statistics in this agreement.


I agree to pay a fee of $30.00 for tuition paid after the due date.


I understand that I am responsible for the terms of payment as stipulated above.


Signature                                              Relationship                          Date


Signature                                              Relationship                          Date

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