11
Paradise Childcare Handbook Licensed Childcare Programs Toddler – Age 1yr to 3yrs Kinder-prep – 2.5yrs to 5yrs Hours – 7:30am to 5:30pm ************** Before and After School Care Hours – 7:00am to 5:30pm Absent line – 250-954-8353 – Parksville Absent Line – 250-619-6384 - Qualicum [email protected] ************** Qualified Staff – Central Locations Subsidies Available 330 Craig St. Parksville (Craig St. Commons) – 250-586-8688 744 Primrose Ave Qualicum Beach (Qualicum Commons)– 250-619-6384 [email protected] paradisechildcarebc.com

Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Paradise Childcare Handbook

Licensed Childcare Programs

Toddler – Age 1yr to 3yrs Kinder-prep – 2.5yrs to 5yrs Hours – 7:30am to 5:30pm

************** Before and After School Care

Hours – 7:00am to 5:30pm

Absent line – 250-954-8353 – Parksville Absent Line – 250-619-6384 - Qualicum

[email protected]

************** Qualified Staff – Central Locations

Subsidies Available

330 Craig St. Parksville (Craig St. Commons) – 250-586-8688 744 Primrose Ave Qualicum Beach (Qualicum Commons)– 250-619-6384

[email protected]

paradisechildcarebc.com

Page 2: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Philosophy and Mission Statement Philosophy At Paradise Childcare, we believe that each child should be honoured daily. We provide a setting that respectfully engages children in play-based learning experiences. We value and promote social, emotional, physical and cognitive development through the avenue of play. Mission We strive to provide superior leadership, support and opportunities for families and their children to develop their full potential in our childcare setting through positive nurturing and guidance. Community connection, interaction and involvement is a key component to our programs.

Welcome to Paradise

We are excited to welcome your precious little one to start our program as I'm sure they are too! Please be sure to pack an extra full change of clothes to leave at the centre, we ask that you put them in a large zip-lock bag labeled with your child's name, a pair of waterproof pants or muddy buddy suit and rubber boots, also a wide brim sun hat and closed toe sandals for those warmer months, be sure to LABEL EVERYTHING. In our Parksville location we provide 2 snacks but we ask that you pack healthy lunch for your child, our centre promotes only healthy eating so we request 2-3 small servings of cooked or raw vegetables, and a healthy protein. In our Qualicum location parents need to supply 2 healthy snacks and a nutritious lunch. We frown upon processed foods and will gladly send them back home if they are brought. We only serve water, so please don't pack any juice or yogurt drinks. We have a labeled water bottle for all the children so you need not pack one. We also encourage a waste free environment so please try to use reusable containers whenever possible labeled with your child's name. Upon arrival children will hang up their backpacks; remove outside shoes and put on their inside shoes, children will then wash their hands before they begin their play. Please send a pair of indoor running shoes labeled to leave at the centre as these will be worn during our gym time as well.

Arrival and departure We request all children to arrive clean and with full tummy’s. It is normal for children to be hesitant and sometimes even cry when dropping them off. Please be very brief (no more than 5 minutes is sufficient) during drop off times; the longer you prolong the departure the harder it gets. A smile, cheerful good-bye kiss, and a reassuring word that you will be back is all you need to do. Please be very brief at pick up times, this is a time of testing when two different authority figures are present (the parent and the provider) and some children will test to see if the rules still apply. It is important that you back up our rules at this time, but if you do not we will remind your child of inappropriate behaviors being displayed and take action to correct them if needed. We ask to please be in control of your child during pick up and drop off times. Do not allow your child to run out to your car while you are still inside, our safety rule is "No one goes outside the gate without their parent/guardian with them." Although parental communication is vital we prefer drop-off and pickup to not be the time to discuss problems. If there are any problems or concerns, please call or email Paradise Childcare we will be happy to discuss outside of the classroom privately. Thank you for allowing us this opportunity to get to know and take care of your precious little ones.

Payment and Administrative Information

All correspondence is to be done through email to [email protected] or the office phone 250-586-8688.

Payments are to be made on or before the first of each month to avoid late charges. A fee of $5.00 per day will be charged

on late payments

Preferred Payment is E-Transfer to our email at [email protected] security question … where is head office

located? Answer – Parksville.

Please put the INVOICE NUMBER on the E-Transfer notes so we are sure to apply the payment correctly.

Page 3: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

The online invoices you receive are best viewed on a laptop or desktop computer.

The on-line invoices are also your tax receipts.

Please check your email for invoices around the 25th

of the month…we will send them out around then and again on the last

day of the month as a friendly reminder.

If you are not receiving invoices, please contact us right away to be sure we have your correct email.

AFTERSCHOOL Absences: We require families to inform the centre if a child will be absent for any reason. You must advise the attendance line at 250-954-8353 (Parksville) 250-619-6384 (Qualicum) by phone prior to 2:00pm or a $20 administration fee will be applied. (school age program) Parents late at pick up time: There will be a late fee of $1.00 per minute charged and will be added to the next months invoice. At 5:35PM Paradise, will start calling people on your emergency call list. At 6:00 PM, if Paradise is unable to contact anyone to pick up your child they will contact The Ministry of Social Service, as stated in the Release of a Child Policy. Registration Fee = $50.00 Please know in confidence by providing Paradise Childcare with your personal email it will not be given to any secondary party and will only be used for matters directly involving Paradise Childcare and the care of your child or children.

CENTRE POLICIES

Weather policy It is important that children are equipped with waterproof rain jacket, waterproof pants, and rubber boots all year long as we know the West Coast rain can hit at anytime. It is our policy that if children need to have sunscreen applied that it be done at home before commencing care or brought from home and applied by your child on their own. We ask that children are equipped with the proper attire for the outdoors in sunny weather to protect their bodies which would include a wide brim sun hat that covers face, ears, neck and shoulders with an under the chin strap. It is also advised that children wear shirts that cover their shoulders (no tank tops or spaghetti straps) UV protective shirts are ideal. We practice safe sun play outside with lots of time spent in the shade. We are fortunate that our play spaces have plenty of shaded space and our staff is diligent in making sure all children get adequate water while playing in warm weather. If your child is extra susceptible to sun exposure and needs more attention we ask that you seek medical advice and advise Paradise of these needs therefore we can accommodate a particular situation and fill out the necessary forms for our staff to administer topical lotion for outdoor play time. It is important that our bodies are exposed to some level of pure sunshine. Our skin absorbs the immense amount of natural vitamin D the sun radiates and stores it up over time then slowly releases it into our bodies in the darker months, so as long as we are all sun smart and safe we can play in harmony! In the winter months, it is mandatory that children are sent with warm waterproof gloves, warm toque/hat and a warm coat. Also, Parents, please remember that it is your responsibility to check and replenish your child’s bin with extra pants, shirts, socks and underwear as needed.

Page 4: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Wellness and Illness Policy

At Paradise Childcare we hold a high regard for health and wellness. We use natural cleaning and sanitizing solutions to ensure children are safe from toxic chemicals and carcinogens. It is important that our children and staff take precautionary steps to prevent the spread of germs, to practice this we enforce regular hand washing rituals for example; upon arrival, before meals and after returning from outdoor play also implements regular surface and toy sanitation. We require children attending our programs have well maintained hygiene for example; clean hair & clean clothes. If there are any concerns in this area we will work towards solving the problem and discussing any issues. If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask this for two reasons we don't want the spread of viruses in the child care environment and when a child is sick they need to feel the comfort of home and get adequate rest to ensure a speedy recovery. Your child should not attend Paradise if they suffer from the following symptoms:

complaints of unexplained or undiagnosed pain,

suffering from a common cold,

difficulty to breathe,

high fever (100 F / 38.3 C),

sore throat or trouble swallowing,

infected skin or eyes

undiagnosed rash, headache and stiff neck,

unexplained diarrhea, nausea and vomiting,

sever itching of either body or scalp, parasite related conditions (impetigo, scabies, head lice etc.)

or if your child has a known or suspected communicable disease. If your child has or is sent home for an illness or suspected illness they must be free and clear of all symptoms for at least 24 hours before returning to Paradise or have been examined by a doctor and has received medical clearance for an infection or parasite related condition. In the event your child becomes ill while in our care we will contact the parent/guardian and request that your child be picked up immediately, while waiting we will keep your child in a comfortable and quiet place. In case the parent/guardian is unreachable we will get in touch with their alternative contact to pick up your child. If the situation should be a major medical emergency we will contact an ambulance to transport your child to the hospital to be treated, you the parent/guardian will be responsible for the bill. Our staff will not administer any medication to your child unless it has been prescribed by a doctor. At this time, a parent/guardian will need to produce a doctor’s note and a written consent form is also required. In the event your child is diagnosed with a serious illness or contagious disease of a communicable nature we will need to be notified within 24 hours so our centre can take the precautionary steps necessary to prevent future spread.

Food and Drink Policy Families are encouraged to provide nutritious food which we will help prepare as required. Water will always be available to the children throughout the day and be served with snacks and lunch. We supply a labeled water bottle for each child, no juice or yogurt drinks are permitted. At no time will food or drink be used as a form of reward or punishment for the children. In our Parksville program we provide 2 snacks, we ask parents to pack a nutritious lunch that consists of 2-3 vegetable servings cooked or raw and a healthy protein or carbohydrate. On occasion we provide special treats such as popcorn, smoothies, etc. In our Qualicum location we require you to be responsible for packing 2 healthy snacks and a nutritious lunch. Our scheduled eating times are 10am morning snack, 12pm lunch, 3pm afternoon snack. Snack logs are recorded in and kept on file for all food programs.

Page 5: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

NUTRITIOUS LUNCHES IDEAS

Sandwich, wraps or similar bread/grain (rice) & protein - suggestions: meat or alternatives, cheese, fish, yogurt, tofu, (peanut butter-if no food allergies), etc.

Examples:

Cut up fruit (grapes, melon, cantaloupe, strawberries)

Cut vegetables (cucumber slices, celery sticks, carrot sticks)

cereal

nuts

dried fruit

yogurt

small muffins

pizza

Sushi

Cheese - cubed or slices

Children love small amounts of many different things. The items you put into their lunches do not have to be prepackaged to be fun and nutritious. Make your own packages, it will save you money. Some children like food in small amounts so please remember to supply a variety of choices. Be creative and have fun, it also helps if your child is involved in the food preparation process.

***NO JUICE BOXES, CANDY, CHOCOLATE, SUGARY TREATS OR PUDDINGS***

Canada’s Food Guide for ages 4 to 9 which states daily requirements are:

5 to 6 servings of fruit and/or vegetables

4 to 6 servings of grain products

2 to 4 servings of milk and alternatives

1 to 2 servings of meat and alternatives

Please only use reusable containers and refrain from plastic bags and plastic wrap.

Release of a Child Policy

Children will only be released to those persons who are authorized to drop off or pickup who are on the form. Written permission and picture ID must be presented to the person in charge, for your child to be released.

If the parent or person authorized to pick up the child is incapable of providing safe care for that child ie. (smells of alcohol, drugs or appears intoxicated) the person in charge will follow the following procedures:

Offer to call an alternative parent or relative or friend to pick up the child.

Offer to call a cab.

Inform the parent or person picking up that if they choose to get in the car with or without the child, the person in charge

will immediately call the RCMP 911

Call the Ministry of Social Services if the person in charge feels the child needs protection.

Record events in communication journal.

If an unauthorized person arrives to pick up a child, Paradise will follow the following procedures.

Attempt to contact the parent or guardian to request written authorization or pick the child.

Attempt to contact emergency contact person to pick up the child, If unsuccessful, Paradise will contact the RCMP 911

Page 6: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

If no one arrives to pick up a child Paradise will follow the following procedures.

Attempt calling the parent, guardian and or emergency contact person.

After a child has been in care for 10 hours or the centre is closing, the staff will attempt calling the parent, guardian or emergency contact person again.

If Paradise staff are unable to contact anyone to pick up your child, they will contact The Ministry of Social Services.

Paradise Guidance

At Paradise Childcare, we maintain a positive approach as a method of guidance. In guiding the children’s behavior, we are assisting the children in becoming more self-disciplined. Through this process, they are learning appropriate and acceptable behaviors. We believe that each and every child is unique. Understanding and accepting that children differ in terms of activity levels, distractibility and sensitivity we are able to be prepared to offer effective and appropriate nurturing guidance. Steps we take to guide the Children

• We arrange the learning environment with learning centres that are separate and clearly defined. In addition we provide the children with ample developmentally appropriate activities and materials.

• We follow a predictable schedule which is important in helping eliminate inappropriate behavior, this provides the children a sense of security and confidence in knowing what to expect.

• We involve the children in making rules and establishing limits so that they will have ownership over them. In addition, we encourage the children to settle difference themselves with our support if needed. Our goal is to find an agreeable solution to all.

• We state clear behavior expectations and offer choices. We use redirection, limits and logical consequences for the children who engage in undesirable behavior.

• We observe children at play to see that the environment is meeting their developmental needs. In the event that the environment is not meeting the needs of all the children, we will make the necessary changes.

• When a child is out of control and may harm someone else, themselves or damage equipment we will provide an opportunity for them to self-redirect and a quiet space if needed. We use a choice of something quiet to do until they are ready and feel they are able to manage their behavior more appropriately.

• Parents will be notified if their child’s behaviors is constantly inappropriate, we encourage working together as a team to find a solution and provide any help or changes the child may need.

At Paradise Childcare, our goal is for your child’s experiences away from home to be positive and enjoyable. We are here to help your child be successful at all their endeavors.

Emergency evacuation Policy

Preparedness is Everyone’s Responsibility

We strongly advise you to have two back-up plans for childcare in the event that we experience a disruption to our

operations or that your child suffers from an infectious illness or fever and cannot attend for safety reasons.

Please ensure that your child:

Has adequate indoor footwear (no lace-up)

Seasonally suitable clothing

Sufficient food for the entire day

Please note carefully:

If your child has a fever please keep your child at home or with alternate care until your child has been without a fever for

at least 24 hours.

Any illnesses currently active in the facility, parents/guardian will be notified via email as soon as possible.

Page 7: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

In the case of power failure during normal hours of operation that lasts 60 minutes or more we will be calling parents to

come and collect your child as soon as possible.

In the case of a power failure overnight do not bring your child to Paradise unless you have contacted the facility and

confirmed that they are open for business. You may also listen to the local radio station for updates on school closures and

openings.

In the event of a formally declared emergency/disaster, locally, regionally or provincially: please collect your child as soon

as possible. If you cannot collect them yourself, please contact one of your pre-designated alternates to do so.

If an event occurs overnight, do not take your child to Paradise unless you’ve confirmed with the facility that it is open and

in operation.

In the event of a pandemic influenza occurrence, the facility will be closed until notified by the Chief Medical Health Officer

that the facility can re-open. If a pandemic occurs there is an excellent document, “Look After Yourself” available through

the auspices of Vancouver Coastal Health. The link follows” http://www.vch.ca/pandemic/docs/Look_after_yourself.pdf

If for any reason Paradise is required to close due to a localized event/ issue at that particular facility you will receive a

phone call or email and be given specific information.

Emergency Closure of Schools in District 69 (Policy #7160):

Schools are rarely closed due to power outages or weather conditions. Most power failures are of short duration. During

inclement weather some bus routes may be cancelled, therefore our afterschool program will be closed. During very severe

conditions, schools may be closed. When schools are closed we will be following the same policy, we will be closed, and

parents need to pick up their children asap There also may be occasions when morning bus runs are limited or cancelled due

to hazardous road conditions. There will be announcements on the local radio station "The Beach" (CIBH - 88.5 FM) and on

School District 69 website “ www.sd69.bc.ca” as well emails from Paradise.

Holidays and Closures Paradise Childcare is closed for all statuary holidays, one week between Christmas and New Years and the last week of August resuming after the Labor Day weekend.

Centre Rules

The following rules are reinforced for the safety and wellbeing of everyone.

There is no running in the centre, no hitting, pushing, biting, grabbing, kicking, pinching the other children or care providers.

Obscene language is not tolerated.

Respectful treatment of other children and all property, toys, and furniture is expected. Willful destruction of property will be charged to the parent at the cost to replace the item.

We request drop off no later than after 9:30am for ALL programs

There will be no visits or interruptions during quiet time from 1:00pm to 3:00pm

Please leave toys and personal items at home, our facility has adequate supplies for all children.

Required items for Paradise,

Muddy Buddy (rain suit) or waterproof pants (Kidsville in Parksville offers 20% off)

Weather appropriate jacket

Gloves

Hat

Weather appropriate outdoor shoes

Indoor shoes (preferably sneakers, however slip on shoes are also acceptable no lace-ups)

Bag of extra clothes (minimum of two outfits consisting of socks, pants, shirt, underwear)

Diaper wipes

Diapers

Diaper cream

PARENTS PLEASE ENSURE ALL OF YOUR CHIDRENS BELONGINGS ARE LABELLED (this includes lunch kit, containers, pacifiers, bottles, diapering items, clothing, etc

Page 8: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Paradise Childcare Centre Contract The following agreement is made between:

(1) Parent/Guardian Name(s): _____________________________________________________________

(1) Mailing Address: _____________________________________________________________________________ _____________________________________________________________________________ (1) Home Phone: _________________Work: _____________________ Cell: _________________ (1) Email Address: _____________________________________________________ AND (2) Parent/Guardian Name(s): _____________________________________________________________________ (2) Mailing address: _____________________________________________________________________________ ______________________________________________________________________________ (2) Home Phone: ___________________Work: _____________________ Cell: ________________ (2) Email address: ___________________________________________________________ AND Sarina Tryon and her staff at Paradise Childcare Centre Manager: Sarina Tryon - [email protected] Office Phone – 250 586-8688 at 330 Craig St., Parksville, BC Owners – Sarina Tryon & Joye Lennox Mailing address – 127 Acacia St. S. Parksville, V9P1H4

Page 9: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

The care provider shall look after and be responsible for

________________CHILDSNAME________________________________________

The care shall commence

From (times during the day) ____________ to __________________

o On (days of the week) ____________________________________________________

o Care giving shall commence on (date) ________________________________________

o If the child is ill or away for any other reason and cannot attend Paradise, the Parent/Guardian is responsible for

paying the above fee unless Paradise, using reasonable efforts, can find a temporary replacement. If the child is

ill or has come in contact with a communicable disease the Parent/Guardian shall notify the Paradise

immediately.

The Parent shall pay a daily/weekly/monthly fee of _______________ due and payable on or before the first of the month.

All correspondence is to be through email to [email protected] or the office phone at 250-586-8688.

Paradise will be closed on all stat holidays, fees are still applied.

Payments are to be made on or before the first of each month to avoid late charges. A fee of $5.00 per day will be charged

on late payments unless previous arrangements have been made.

Preferred Payment is E-Transfer to our email at [email protected] security question … where is head office

located? Answer – Parksville.

Please put the INVOICE NUMBER on the E-Transfer notes so we are sure to apply the payment correctly.

If the Parent/Guardian is in receipt of child subsidy, then the Parent/Guardian shall pay their portion of the child care fee in advance of the date it is due and owing. Late fees will apply. If payment is not received on time Paradise Childcare reserves the right to terminate care without notice. WITHDRAWAL OR CHANGE IN AGREED SCHEDULE: An advanced 4-week written notice is required if you wish to withdraw your child from a program or change the above agreed schedule. Failure to do so will result in your forfeiting one month of your regular fee. *** Parent Initial _________***

If the care provider is unable to provide care for your child, for a pre-paid space at Paradise, the centre will give

the Parent/Guardian a credit, for the pre-paid space. No refunds will be given on pre-paid spaces. Either party

may terminate this agreement by giving four weeks written notice to the other party. If there is a safety issue

or any other extraordinary circumstances, Paradise reserves the right to terminate the contract immediately

without notice.

In the event of accident or illness for the child, the Parent/Guardian authorizes the Care provider to contact a

doctor or ambulance and the Parent/Guardian agrees to pay any costs thereof.

If the Parent/Guardian fails or is unable to pick up your child at the agreed upon time, the Parent/Guardian shall

pay an overtime fee of $1.00 for each minute of overtime care provided by the Caregiver. Overdue fees will be

applied to the next months invoice.

If the Parent/Guardian fails to notify Paradise of an afternoon absence by 2:00pm of that day, a $20.00

Administration fee will be applied. (school age program)

The Parent/Guardian gives permission to the Care provider for the following:

a) Spontaneous walking trips _______yes _______no

b) Child photographs for general use in the in the Childcare Centre _______yes _______no

Page 10: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Paradise Childcare Centre has the following obligations:

To supervise child’s safety and wellbeing at all times while in care.

To apply sun screen or diaper cream if so authorized and provided by the Parent/Guardian.

To refuse any person other than the Parent/Guardian to pick up child without written permission from the

Parent/Guardian.

The Parent/Guardian has the following obligations:

To notify the Care Provider, in advance of any allergies of the child (e.g. peanut butter, chocolate, wheat, dairy).

To pay fees promptly and on time.

To pay $20.00 plus any bank charges for NSF cheques.

To provide diapers, prescription drugs, sunscreen or diaper cream lotion when required.

To keep the child home if the child is ill (e.g. within the last 24hrs.) (Diarrhea, vomiting, high temperature, etc.)

Diarrhea is highly contagious.

Absences must be reported by 2pm the same day (school age program) – A$20.00 fee may apply if daycare is

not advised.

Probation Period Paradise Childcare Centre reserves the right to terminate the contract immediately without notice in the first 30 days of care in attendance.

Termination

We appreciate as much advance notification of withdrawal as you can give and in return, will give you the same courtesy with a 4-weeks’ notice of our intent to terminate our agreement. However, we reserve the right to terminate our contract immediately for any of the following reasons (but not limited to):

Non-Payment, continual late payments, or NSF checks

Lack of compliance with Handbook Policies

Failure to complete and return required forms

Physical or verbal abuse of any person or property

Continual disciplinary problems

Lack of respect for the provider or other children, by the parent or child

False or lack of information given by parent either verbally or in writing

Failure of child to adjust to the center after a reasonable amount of time.

Paradise’s inability to meet the child's needs without additional staff

Page 11: Paradise Childcare Handbook - Child Care Parksville ... · If a child is sick we ask that that you please keep them at home until they are completely free of all symptoms. We ask

Policy Changes

We will review and revise our handbook of policies and procedures as well as our contract as we deem necessary. Annual fee increase will go into effect the first of September each year or as needed. However, we reserve the right to make any policy or financial changes at any time when it is in the best interest of Paradise Child Care Business. We will give a minimum of 30 days’ notice of any these changes.

Waiver

Lack of enforcement of a certain policy at any time does not indicate that the particular policy is no longer in effect. If we do not exercise a right that is provided by this agreement, it does not mean we have given up that right.

I have completed and signed the registration/health form for my child/children and I have read and understand the policies of Paradise Child Care Centre. I have submitted and/or agreed to pay the required 50.00 registration fee.

_________________________________________ (PARENT/GUARDIAN)

Any and all additions/changes to this contract must be initialed by both the parent and the provider to be valid. I have read and fully understand this contract. By signing this agreement, I agree to comply with all terms herein. Parental Signature: _______________________________________________________ Date: ______________ Parental Signature: _______________________________________________________ Date: ______________ Childcare provider Signature: ________________________________________________ Date: ______________

******************************************************************************

A copy of this contract was returned to Parent/Guardian _____________

(Parent/Guardian Initials) Date ___________________