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NASREEN'S HELPING HANDS PARENT AGREEMENT

Please Read the following carefully and sign ADMISSION & ENROLLMENT REQUIREMENTS A. Full Time means Monday through Friday. (Maximum of 9 hours per day) B. Ages of admission for our Early Childhood program are infant through five years C. The following forms required by the state of California need to be completed prior to placement. 1) Registration form signed by parent or guardian, which includes the date of last physical examination and complete record of immunizations. 2) Written consent for child to receive medical treatment. 3) Signed policies and procedures agreement. 4) A signed fee and payment plan (Parent/Provider Contract) with a copy to parent. Agreement is entered into on this ___________________day of_____________month___________, 19______year Betweeen Nasreens Helping Hands and the family of Parents Name(s)______________________________________________________ Child(rens) Name______________________________________________________ Address_____________________________________________________________ A. GENERAL AGREEMENTS The above children will attend on the following days: Monday Tuesday Wednesday Thursday

Friday

The hours the child(ren) need care are:____________AM-_______________PM For the above listed hours, we agree to pay: $________________hourly daily weekly monthly We understand: 1. That this payment is a guaranteed rate and includes full pay for holidays with no credit for absent days. 2. Payment is to be made to secure and maintain the position of the child on the providers roster. 3. All payment reflects the above schedule. 4. Payment shall be made on Monday for the coming week Read and Agreed upon__________________

ABSENCE: If your child is going to be absent for any reason, please notify us at 408 262-5582 no later than 8:00am on that day. Your agreed-upon rates will not change due to absence. ARRIVAL & DEPARTURE, CHILDRENS SUPPLIES, & VISITATIONS ARRIVAL & DEPARTURE: 1. Please do not bring your child to school before the time you registered him to be here. We set our schedule by the registration information. 2. Children are expected to arrive no later than 9:00am unless otherwise arranged. 3. Children are to be neatly groomed and dressed in clean clothes (and diapers) upon arrival. 4. It is very important that you be on time to pick up your child. There is a fee of $5 if you are 10 min. late. This fee will increase $5 for every 5 min. until you arrive. Tardy time starts after your registered hours. For example: If your child is registered to be in childcare until 12:30 and you arrive at 12:40, there is a $10 tardy fee. If someone else will be picking up your child, please write down their name(s) below

. You will also want to let the person picking up your child know to bring picture ID. Read and Agreed upon__________________
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HOLIDAY CLOSURES: Nasreens Helping Hands Child Care will be closed on the days listed below. If the holiday falls on a weekend, then we will be closed the same days as the federal and state offices. There is no discount for the days we are closed. They are considered paid holidays as part of our employee benefits package. The following days are national holidays we observe by closing: New Years Eve New Years Day Presidents Day Memorial Day Fourth of July Labor Day Thanksgiving and Friday Christmas Eve and Christmas Day Two Eid Muslim holidays per year (will notify in advance) Vacation (will notify in advance and one week of this will be paid) All extended time off, including vacations will be charged at half of the agreed upon rate. Read and Agreed upon__________________

B. LATE FEES 1. Payments received after 5:30pm on the due date are considered late. 2. Fees for late payments are as follows: a. $20 if payment is not received within two (2) business days of the due date. b. Service will be suspended if payment is not received within 5 business days of the due date. c. If late fees become continuous problem, the provider reserves the right to terminate this agreement and care for the child(ren). 3. There is a $20.00 fee for returned checks. Acceptable forms of payment are check, money order, cashiers check, or cash. Read and Agreed upon__________________ C. WITHDRAWL E 1. Parents, who wish to discontinue childcare service with Nasreens Helping Hands Child Care, must give two weeks (10 days) advanced notice of withdrawal. 2. Your child will be considered withdrawn without notice if you do not inform Nasreens Helping Hands Child Care of any absences in excess of 1 week excluding holidays. Please inform us (in advance if possible) of any absence. 3. If your child is withdrawn without notice, one weeks tuition will be charged from the childs last day of attendance. Read and Agreed upon__________________
A.

TERMINATION OF SERVICES: a. There will be a trial period of one week after which either party can choose to continue or terminate this contract. After the probationary period, two weeks notice is effective.

Reasonable steps will be taken to avoid termination, however, Nasreens Helping Hands Child Care may immediately terminate services without cause or for any of the following reasons: 1. Late payments, returned checks, or any other problems with payment of tuition and fees. 2. Failure to honor the obligations listed in this contract, the Parent Handbook. 3. Any actions by parents or children that adversely affect the program at Nasreens Helping Hands Child Care. 4. Failure to cooperate with Nasreens Helping Hands Child Care in matters which the facility determines serious enough to warrant termination. 5. Misleading information on application Read and Agreed upon__________________

Nasreen's Helping Hands Enrollment Record Childs Name (Last, First,


Middle)_____________________________________________________________ Birthdate ______________________ Sex M F

Fathers Name (Last, First,


Middle)___________________________________________________________ (Drivers License#)_______________ Home Address: Street Home Phone___________________ City: State: Zip:

Cell Phone______________________

Place of Employment______________________ Work Hours________ Work Address: Street Work Phone___________________ City: State: Zip:

Mothers Name (Last, First,


Middle)__________________________________________________________ (Drivers License#)_______________ Home Address: Street Home Phone___________________ City: State: Zip:

Cell Phone______________________

Place of Employment______________________ Work Hours________ Work Address: Street Work Phone___________________ City: State: Zip:

Authorized Pickup Name (Last, First,


Middle)______________________________________________ (Drivers License#)_______________ Home Address: Street Home Phone___________________ City: State: Zip:

Cell Phone______________________

Place of Employment______________________ Work Hours________ Work Address: Street Work Phone___________________ City: State: Zip:

Authorized Medical Care


Doctor (Last, First)______________________________________________ Address: Street Phone___________________ Dentist (Last, First)______________________________________________ Address: Street City: State: Zip: City: State: Zip:

Phone___________________ Hospital ______________________________________________ Address: Street City: State: Zip:

Phone___________________ I hereby authorize Nasreens Helping Hands Child Care to take my child to the above named physician or facility for medical treatment in the event of an emergency in which neither parent can be reached. Signature Date

I hereby authorize Nasreens Helping Hands Child Care to treat my child in case of an emergency in which the above named physician cannot respond. Signature Date

Contract Changes and Removal A two week written notice may be used if any major contract changes are made. The changes may include fee increases. If you have any questions regarding this contract, please ask as soon as possible. A copy of this contract will be kept in your childs files, however you may wish to keep a copy as well. Grievance Policy It is important to me that if any problems arise that you communicate them to me immediately. If you feel any situation warrants a meeting after hours, please ask to schedule one during a convenient time for you. I would also like to inform you of your right to contact Community Care Licensing at (408) 277-1286 Arbitration Clause: I agree on behalf of myself and my child that any tort, statutory, or contractual claim or dispute arising of the services provided by this contract will be settled by binding arbitration administration administered by the American Arbitration Association. I agree to have a court enter judgment on (and for my child approve) any award of settlement. I have read the Policies and Procedures and accept all the conditions stated therein. Parents Signature_____________________________Date______________________ Parents Signature_____________________________Date______________________ Providers Signature___________________________Date______________________