Child's Name: _____________________________________
Date of Birth: ____________________________
Monday: _____ to _____
Tuesday: _____ to _____
Wednesday: _____ to _____
Thursday: _____ to _____
Friday: _____ to _____
Start Date: _______________________

I agree to pay a $50 deposit to hold my child's spot for no longer than 2 weeks in the program. I understand that if I change my mind about my child attending MunchkinLand, the deposit is forfeited. I agree to pay $_____ payable to Lauri Smit upon arrival on the first day of each week that my child is contracted to be in care for the current week. I understand that if I pay in cash, Miss Lauri does not have change. I understand that my fees are based on enrollment, not attendance, and no credit is provided for absenses due to illness or other reasons. I understand care for my child will not continue if I do not pay the fee on time and that a $10 per day late fee will be applied. I agree to pay an overtime rate of $5 per 15 minutes (or part of 15 minutes) if I pick my child up later than the departure time listed above or if I drop my child off earlier than the arrival time listed above. I agree to pay a $25 fee in the event of a returned check and I understand that I will have to pay in cash only thereafter. I agree that if I do not give a two-week (14 calendar days) written notice when terminating childcare services, I will pay for two weeks (weekly fee listed above X 2) of care in lieu of notice.

I agree that when I give two weeks written notice for vacations, I will receive two weeks of vacation (the number of days my child is contracted to be in care per week X 2) per contract year at no charge. I understand that unused vacation days may not be carried over to the next contract year and may not be used in lieu of holidays (New Year's Day, Memorial Day, 4th of July, Labor Day, Thanksgiving, Christmas), which are paid for by me if the holiday falls on a day of the week my child is contracted to be in care. *Specific dates will be on the monthly calendars.

I agree to deposit and retrieve my child's belongings to and from the cubby and check the mailbox for notes each day. I agree to provide formula or breastmilk, bottles, baby food and cereal, bibs, diapers and wipes.

I agree to keep my child home when s/he is displaying, or has displayed within 24 hours, a fever (>99F under arm; >100F orally; or >101F rectally), diarrhea, vomiting, or symptoms of any communicable disease (rash, sore throat with swollen glands, severe coughing, eye discharge, yellowish skin or eyes, green or yellow or clear and thick runny nose) or if the child is irritable, continuously crying or requires more attention than Miss Lauri can provide without endangering the health and safety of other children in care, and will come pick up my child if s/he becomes ill while in care. I understand that my child may attend with mild cold symptoms (clear, watery runny nose, happy and playful, no fever), but if the symptoms persist for more than the usual 7-10 days or are worsening, I will be asked to remove my child and seek medical attention to be sure a secondary infection has not set in. I agree to give at least one-half hour notice when my child will not attend daycare for the day or will be arriving late and I understand that my fees remain the same. I understand that I will have a one-hour window to pick up my child before emergency contacts are notified. I understand my child may return to MunchkinLand when s/he is free of symptoms for 24 hours and/or has been on antibiotics for at least 24 hours and is no longer contagious. I agree that I or my insurance company is responsible for the cost of medical help and/or treatment due to accidents or illness while at MunchkinLand.

I understand that I am responsible for providing back-up childcare in the event MunchkinLand may have to close due to illness or vacation and that payment is not required for such instances.

I agree to send my child to daycare dressed in durable play clothes appropriate for the child's size and the weather. I agree to keep a labeled complete change of clothing in my child's cubby.

I agree to not send food (including candy or gum, except infant food/formula) or toys (or coins or small hair accessories/jewelry) with my child to daycare. I understand that MunchkinLand provides breakfast from 7:30am to 8:15am, lunch from 11:30am to 12:30pm, and afternoon snack from 3:00pm to 3:30pm. I agree to notify Miss Lauri if my child will not be in attendance for a meal or if I decide to feed my child at home before arrival.

I understand that when I enter MunchkinLand to pick up my child, s/he no longer under Miss Lauri's supervision and I am responsible for the safety and behavior of the child at that time. My child will be supervised and not be allowed to go upstairs or outside alone. For the safety of other children, I agree to not leave my vehicle running when I drop off or pick up my child. Any children not enrolled in MunchkinLand that accompany me during pick-up will also be supervised by me at all times. As per MunchkinLand's liability insurance policy, non-enrolled children are not insured. Therefore, areas other than the entrance area are off-limits.

I understand that medication must be in its original container, clearly labeled, sealed in a Ziploc-type baggie and labeled with the child's name on it, and given directly to Miss Lauri. I agree to not leave medication of any kind in a diaper bag or the child's cubby (including diaper rash cream, sunscreen, bug spray). I agree to complete a medication permission form, which is required by the state, for all medications my child needs.

I understand there is no smoking on the premises at any time and agree to refrain from smoking and will notify anyone else who drops off or picks up my child of the same.

I understand that I will be responsible for at least 50% of replacement costs when toys or other items are damaged by me or my child either intentionally or due to excessive roughness of the child after being asked not to, or because s/he broke a rule.

I agree to follow the policies stated herein concerning the care of my child. This contract will remain in effect until review or revision on or before one year from the date signed. This contract is subject to early termination without prior notification in the event of any breach of this agreement by parents or guardians; in the event that the child becomes disruptive or ungovernable in the opinion of the provider; failure of child to adjust to the center after a reasonable amount of time; or if the parent continually brings the child to MunchkinLand while ill; verbally or physically abuses or assaults Miss Lauri or another child/parent, threatens or harasses Miss Lauri or another child/ parent, steals or vandalizes against Miss Lauri or another child/parent, uses or is under the influence of drugs or alcohol in Miss Lauri's home or on Miss Lauri's property, brings or displays any: weapon, drug or paraphernalia, or pornography, into Miss Lauri's home or on Miss Lauri's property, failure to provide the required forms for enrollment; non-payment of childcare fees or late fees; non- compliance with policies and procedures; unwillingness to work with the provider on issues relating to the child; non-payment of fees and/or late fees; an accident or catastrope (act of God, severe medical illness, etc) which would warrant an abrupt closing of MunchkinLand; and the death of Miss Lauri or another close family member. I understand this contract is a legal and binding document and will be treated as such.

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Parent/Guardian Signature Date

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Parent/Guardian Signature Date

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Provider Signature Date