Parent-Provider Agreement

I, , am registered as a family child care provider with the Maryland

State Department of Education, Office of Child Care (OCC). My registration number is . My

home and household have met health and safety standards established by OCC. I have agreed to operate my

child care home in compliance with Maryland State regulations for the protection of your child. I will strive to

Your and my signatures on this agreement mean that we have read, understand, and agree to the following

provisions:

I/We, , living at ,

(Name/s) (Full Address)

, parents of agree

(Phone Number) (Child’s/Childrens’ name)

(Provider’s Name)

located at beginning on .

1. Hours: Care begins at and ends at on the following days of the week:

. Arrival time is between and ; departure

time is between and . Extra fees of $ for each 15-minute period or portion

thereof will be charged for early drop-off or late pick up which is not pre-arranged. These fees must be

paid the same day they occur. An overtime rate of $ per hour will be provided for pre-arranged

over time at the Provider’s discretion.

2. Fee: The fee for care is $per . Fees are due no later than (day)

by (check, money order, and/or cash with receipt). If not paid the day they are due, there will be a late fee

of $ for every day that the fees are late. If the payment is not made by (e.g. Friday. The

a written agreement, no fee will be charged. In no case may scheduled time for an enrolled child be

used for another child not enrolled in family child care home, unless by written agreement.

Holidays, vacations, and days care will not be available: The family child care home will be closed for

(e.g. New

Year’s Day, Memorial Day, Christmas, all National Holidays, etc.) Fees are/are not charged for all

holidays listed above.

possible if he/she cannot provide care on a given day. It will be the Provider’s/parent’s responsibility to

obtain substitute care on such days. Parents will not be charged when the Provider cannot provide care.

Trial Period: Your child’s adjustment is important to all of us. Therefore, a two-week trial period is

provided before arrangements for continued care become final. At the end of this period, the parent(s)

and provider will discuss how the child has adjusted to the new setting, realizing that this varies from

child to child. At this time, or during the course of the trial period, either party may terminate care upon

immediate notice. After the trial period, the provisions of Section 5, Termination and Withdrawal apply.

Termination and Withdrawal: The Provider reserves the right to remove a child from the family child

Illness and Injury: Parents may not bring sick children to the child care home with fever, rash, vomiting,

diarrhea, or other symptoms of acute or contagious illness, the Provider will refuse to admit the child. A

child should be allowed to recover fully after an illness so other children in the group do not risk possible

exposure.

If the child becomes ill or is injured while in the Provider’s care, parents will be notified and must pick

the child up as soon as possible. If a parent cannot be reached, the person designated on the Emergency

Information Card will be notified.

Safety: As a licensed/registered child care provider in the state of Maryland, all safety regulations are

followed to ensure that children are properly supervised at all times, children are only released to

Medication: The Provider will not administer medication, including aspirin, cough drops, decongestant,

or other non-prescription drugs, as well as prescription drugs without parents’ signed authorization. The

Field Trips: The Provider’s regular program includes neighborhood walks, field trips, and other out-of-

the-house activities which involve transportation of children in vehicles used by the Provider. The

parent(s) hereby grant permission for the child to be taken on such trips and to be transported in the

Attachments: The attached Emergency Information Card, Maryland Immunization Record, Health

Inventory (filled out and signed by a health professional and the parent(s)), Child Release Authorization

and Custody Information (if applicable) and if necessary, Parent’s authorization for medication are part

of this agreement. These forms must be completed prior to admission of the Child to the Provider’s care.

Would you be willing to share your child's IFSP/IEP with me? _____yes_____no

with the Board of Education and others to help your child meet the goals set by the IFSP/IEP committee.

Father/Guardian Signature Date

Provider Signature Date

• Optional:

• I have received a copy of the Parents Guide to Regulated Child Care, or I have been given

Screen Time Statement: The Maryland State Department of Education requires no passive screen time for

children under the age of two and no more than 30 minutes per week for children age two and older.

Written Positive Discipline Policy: I set clear, simple, and consistent rules to help the children learn appropriate

behaviors. When I can, I let the children help make the rules. I offer limited choices which are a good way to

help the children make decisions such as allowing them to choose where they would like to play. I reinforce

positive behavior by giving attention to those who are displaying appropriate behaviors. I redirect children's

behavior by creating another activity or event to draw a child's attention away from an inappropriate behavior. I