Contract/Policy Awareness Signature Form

  1. I have completed the following Contractual Packet material as part of my child’s registration for child care and understand that the forms will be maintained by Country Fun Child Care, until 3 years following discontinuation of care.
  • Financial Agreement
  • Registration
  • Authorization for Pick-up Release (by non-guardian)
  • Release for Permission to Use Likeness
  • Safety Authorization Form/High Risk 
  • Health/Immunizations
  • Sunscreen Usage
  • Transportation, if applicable
  1. Country Fun Child Care’s Handbook, containing at minimum the following information has been made available to me:
  • Ages of Children served
  • Hours of operation and daily schedule
  • Numbers of Children served
  • Specific focus if applicable, such as educational focus, religious focus, Montessori, after-school, summer recreation, teaching site, etc.
  • Opportunities for Parent/Legal Guardian involvement
  • A description of the Child guidance methods used by Staff Members
  • Services offered, such as: basic childcare, care for Children with special needs, part-time care, Infant/toddler care, pre-school care, school-age care, etc.
  • Fees (if any) including charges for late pick-up of Children
  • Vacation policy
  • Terms of any contract or placement agreements
  • The rights of Children
  • Emergency procedures and relocation information
  • Incident reporting and mandatory reporting of Child Abuse or Neglect
  • Expulsion and suspension practices
  • Management of communicable illnesses
  • Medication administration
  • Annual calendar of closure dates (if applicable)
  • Resources available for developmental screenings
  • Reporting of Child death and serious injury 

My signature here indicates that:

  • I have reviewed and completed each form as appropriate.
  • The information I have provided is both current and correct, and will be updated if any change occurs.
  • I am aware of the material required by the State as part of the Family Child Care Licensing Rule.
  • I can access Country Fun Child Care’s Handbook at any time.

Child’s Parent/Legal Guardian Signature:

Print Name:

Date: