How to Use This Template

Fill in every bracketed field before presenting this agreement to families. Do not leave brackets in the final version — they indicate required customization. Have your attorney review the payment terms, termination clause, and liability language before using this agreement.

[CENTER NAME] Childcare Enrollment Agreement

Part 1: Center Information

Center Name: [CENTER NAME] License Number: [STATE LICENSE NUMBER] Address: [STREET ADDRESS, CITY, STATE, ZIP] Phone: [MAIN PHONE NUMBER] Email: [ADMINISTRATIVE EMAIL] Director: [DIRECTOR NAME]

Part 2: Child and Family Information

Child’s Full Name: _______________________________________ Date of Birth: _____________________ Age: _______________ Classroom/Group: _______________________________________

Parent/Guardian 1 — Primary Contact Name: _______________________________________ Relationship to Child: _______________________________________ Home Address: _______________________________________ Cell Phone: _______________________________________ Work Phone: _______________________________________ Email Address: _______________________________________ Employer: _______________________________________

Parent/Guardian 2 (if applicable) Name: _______________________________________ Relationship to Child: _______________________________________ Cell Phone: _______________________________________ Work Phone: _______________________________________ Email Address: _______________________________________

Part 3: Enrollment Terms

Enrollment Start Date: _______________________________________ Program Type: [ ] Full-time [ ] Part-time [ ] Before/After School

Scheduled Days: [ ] Mon [ ] Tue [ ] Wed [ ] Thu [ ] Fri Arrival Time: _____________ Departure Time: _____________

Scheduled hours are established at enrollment. Changes to schedule must be requested in writing with at least [2 weeks/30 days] notice and are subject to availability.

Part 4: Tuition and Fees

Tuition Rate

Weekly Tuition: $ ___________ Monthly Tuition (if billed monthly): $ ___________ Part-Time Weekly Rate: $ ___________ Days per week: ___

Tuition is charged for all scheduled care days regardless of attendance. Tuition does not decrease for child illness, family vacation, holidays observed by [CENTER NAME], or other absences.

Sibling Discount

[ ] Sibling discount applies: [X]% discount on the younger child’s tuition when two or more siblings are enrolled simultaneously in full-time care.

Fee Schedule

Payment Terms

Tuition Due Date: Tuition for the [week/month] of [DATE RANGE] is due on [DAY — example: the Monday of the care week / the 1st of the month].

Accepted Payment Methods: [CHECK / ELECTRONIC PAYMENT / CREDIT CARD — specify which you accept and note any processing fees]

Auto-Pay: [ ] Family authorizes recurring electronic payment from the account on file. Auto-pay enrollments are processed on [DATE].

Late Payment Policy: Accounts more than [X] days past due may result in suspension of care until the balance is paid in full. [CENTER NAME] reserves the right to terminate enrollment for non-payment after [X] days of unpaid balance.

Returned Payments: A returned payment fee of $[AMOUNT] is assessed for any returned check or failed electronic payment. All future payments must be made by [CERTIFIED CHECK / MONEY ORDER / CASH] for [X months] following a returned payment.

Part 5: Attendance Policies

Hours of Operation

[CENTER NAME] operates from [OPENING TIME] to [CLOSING TIME], [DAYS OF WEEK].

Scheduled holidays and closures for the current program year are listed in the family handbook. Tuition is not reduced for observed holidays.

Late Pickup Policy

[CENTER NAME] closes at [CLOSING TIME]. Children must be signed out by an authorized adult by this time.

A late pickup fee of $[AMOUNT] per minute is assessed for any pickup after [CLOSING TIME]. This fee covers the cost of staff required to remain beyond their scheduled shift. Late fees are added to your account and are due with your next tuition payment.

Repeated late pickup (three or more occurrences in a calendar month) may result in enrollment termination.

If a child has not been picked up by [CLOSING TIME + 15-30 minutes] and [CENTER NAME] cannot reach any authorized adult, [CENTER NAME] will contact local child protective services per [STATE] law.

Illness Exclusion Policy

Children must be kept home when they exhibit any of the following symptoms:

• Fever of [100.4°F / 101°F or higher] — child may not return until fever-free for 24 hours without fever-reducing medication
• Vomiting — child may not return until 24 hours symptom-free
• Diarrhea (two or more episodes in a 24-hour period) — child may not return until 24 hours symptom-free
• Contagious or undiagnosed rash
• Pink eye (conjunctivitis) — child may not return until 24 hours after beginning treatment
• Strep throat — child may not return until 24 hours after beginning antibiotic treatment and fever-free
• Lice — child may not return until all live lice and nits have been treated and removed
• Any illness that prevents the child from participating comfortably in activities

If a child develops symptoms during the care day, the parent/guardian will be contacted for immediate pickup. Please ensure [CENTER NAME] has a current phone number where you can be reached during care hours.

Part 6: Health Requirements

Immunization Records

A copy of your child’s current immunization record is required by [STATE] law before enrollment and must be kept current throughout enrollment. The immunization record must be submitted to [CENTER NAME] by [ENROLLMENT DATE].

[CENTER NAME] cannot accept a child into care without a current immunization record on file, unless the family has submitted a state-approved medical or religious exemption form.

You are responsible for updating immunization records when your child receives new vaccinations.

Physical Examination

[ ] [STATE] requires a physical exam completed within [X months] of enrollment. Please provide documentation by [DATE].

Allergy and Medical Conditions

If your child has a known allergy, chronic medical condition, or an Individual Health Plan (IEP, IFSP, or 504 plan), you must provide complete documentation before care begins. For allergies that require epinephrine, a signed medication authorization and current auto-injector must be on file before your child’s first day.

Medication Administration

[CENTER NAME] [will / will not] administer prescription or over-the-counter medications with proper written authorization. All medications must be in the original container with the child’s name and current prescription information. A completed medication authorization form is required for each medication. [CENTER NAME] does not administer medications without a signed authorization form.

Part 7: Authorizations

Emergency Medical Treatment

I authorize [CENTER NAME] staff to take all reasonable steps to obtain emergency medical treatment for my child, including calling 911 and transporting my child by emergency services, if I cannot be reached. I agree to be responsible for all medical expenses incurred on behalf of my child.

Parent/Guardian Signature: _______________________ Date: ___________

Authorized Pickup Persons

The following persons are authorized to pick up my child. [CENTER NAME] will not release my child to any person not on this list or not previously authorized in writing.

I understand that [CENTER NAME] will request photo identification from any person I have not specifically notified the director about in advance. For the safety of my child, I will not ask staff to release my child to anyone not on this list.

Parent/Guardian Signature: _______________________ Date: ___________

Custody and Court Orders

If there are any custody orders, restraining orders, or other court orders affecting who may pick up or have contact with your child, you must provide a copy to the director. [CENTER NAME] cannot enforce custody orders we have not been given. We will follow the most current order on file.

Photo and Video Release

[ ] I authorize [CENTER NAME] to photograph and/or video my child for use in center communications, including the parent newsletter, center social media accounts ([LIST PLATFORMS]), and marketing materials.

[ ] I do NOT authorize [CENTER NAME] to photograph or video my child for any external use. [CENTER NAME] may photograph my child only for internal documentation purposes (incident reports, portfolio).

Parent/Guardian Signature: _______________________ Date: ___________

Part 8: Termination of Enrollment

Family-Initiated Withdrawal

To withdraw your child, provide written notice to the director at least [two weeks / 30 days] before the last day of care. Tuition is due through the end of the notice period, regardless of whether your child attends. Notice given verbally or via text message does not start the notice period — written notice is required.

Refund policy: The registration fee and supply fee are non-refundable. A prepaid tuition deposit of $[AMOUNT] will be applied to the final week/month of care upon receipt of proper notice and completion of the notice period.

Center-Initiated Termination

[CENTER NAME] reserves the right to terminate enrollment with [two weeks / 30 days] written notice for any reason. [CENTER NAME] may terminate enrollment immediately and without notice for:

• Abuse or threatening behavior by a family member toward any child or staff member
• Non-payment of tuition or fees
• Failure to provide required documentation (immunization records, current eligibility forms)
• Any situation that [CENTER NAME] determines poses a risk to children or staff

Part 9: Agreement and Signatures

I have read and understand this Enrollment Agreement. I agree to the policies stated in this agreement and in the [CENTER NAME] Family Handbook, which I have also received.

I understand that this agreement will remain in effect until my child’s enrollment ends or until a new agreement is signed. I understand that [CENTER NAME] may update its policies with written notice to families.

Parent/Guardian 1 Printed Name: _______________________________________

Parent/Guardian 1 Signature: _______________________________________

Date: _______________________________________

Parent/Guardian 2 Printed Name (if applicable): _______________________________________

Parent/Guardian 2 Signature: _______________________________________

Date: _______________________________________

Director Signature: _______________________________________

Date: _______________________________________

Keep the original signed agreement in the child’s file. Provide the family with a copy on the date of signing.