CHOUTEAU DAYCARE

(ENROLLMENT FORM)

            The Daycare operates on the school calendar.  Fees are payable to the Daycare Coordinator EVERY MONDAY MORNING IN ADVANCE.  NO REDUCTION IN FEES FOR ABSENCES. A $5.00 LATE FEE WILL BE ADDED IF NOT PAID ON TIME.

            I will use the Daycare for the following children:

1.      ___________________________________________________________________

Name                                                               Grade               Birthdate

2.      ____________________________________________________________________

Name                                                               Grade               Birthdate

3.      _____________________________________________________________________

Name                                                               Grade               Birthdate

            I WILL USE:               _____Plan I  ($48.00 A.M. & P.M.)

                                                _____Plan II  ($8.00 A.M. only)

                                                _____Plan III  ($40.00 P.M. only)

                                                _____Plan IV ($25.00-pending enrollment amt. EC students only)

Mother’s Name___________________________________________________________

Father’s Name____________________________________________________________

Address_________________________________________________________________

Home Phone______________________________________Work___________________

Emergency Name__________________________________Phone__________________

            I agree to adhere to the fee schedule and the rules of the Daycare for my child/ren.

_______________________________________     ______________________________

Parent’s Signature                                                         Date