PROVIDER AND FAMILY AGREEMENT

Automatic Payment Choice(Required)
Name *Child 1 *(Required)
Name *Child 2
Name *Child 3
Name *Child 4

By signing below, I agree to all terms of this contract and acknowledge that I have received or have access to, through the center's website, a copy of all policies and procedures. This contract is subject to renewal. The provider may amend the policies by giving the parent/guardian a new copy of the policies at least two weeks before they go into effect.

Today's Date(Required)
I agree to this form(Required)