Fee Payment Agreement

 

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

Address:

City/State/Zip:

Phone:

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