[heading "Agreement"]

    * Name of child

    * Pay per:

    * Choose day of week for payment:

    [heading "Services to be provided as part of the day care fee"]

    [text_content "Daily Meals, Snacks, Preschool and Daily Activities"]

    *Child Arrival Time (Starting at 5:30 am)

    [text_content "Late Fee: $5.00"]

    *Childs Departure Time (Ending at 9pm)

    [text_content "Per MIN-HR: 15 minutes"]

    *PERSON(S) DESIGNATED BY PARENT TO WHOM CHILD MAY BE RELEASED

    Extra services to be provided at an additional fee if applicable

    [text_content "I, the Parent/Guardian received complete written program information at the time of enrollment ( Section 3270.121, 3280.121, 3290.121)"]

    [text_content "I, the Parent/Guardian agree to update the emergency contact/parental consent form information, whenever changes occur or every 6 months as a minimum. (Section 3270.124, 3280.124, 3290.124)"]

    *Signature-Parent or Guardian

    * Today's Date