Agency/Parent Contract – Child Attending School "*" indicates required fields Personal InformationChild Name: First Last Start Date: MM slash DD slash YYYY Amendment Date: MM slash DD slash YYYY Days / hours of childcare: Monday Morning Start: Hours : Minutes AM PM AM/PM Monday Morning End: Hours : Minutes AM PM AM/PM Monday Afternoon Start: Hours : Minutes AM PM AM/PM Monday Afternoon End: Hours : Minutes AM PM AM/PM Does the daily schedule repeat?This will copy Monday's schedule to the rest of the week. You can still make changes to each day as required. Yes Tuesday Morning Start: Hours : Minutes AM PM AM/PM Tuesday Morning End: Hours : Minutes AM PM AM/PM Tuesday Afternoon Start: Hours : Minutes AM PM AM/PM Tuesday Afternoon End: Hours : Minutes AM PM AM/PM Wednesday Morning Start: Hours : Minutes AM PM AM/PM Wednesday Morning End: Hours : Minutes AM PM AM/PM Wednesday Afternoon Start: Hours : Minutes AM PM AM/PM Wednesday Afternoon End: Hours : Minutes AM PM AM/PM Thursday Morning Start: Hours : Minutes AM PM AM/PM Thursday Morning End: Hours : Minutes AM PM AM/PM Thursday Afternoon Start: Hours : Minutes AM PM AM/PM Thursday Afternoon End: Hours : Minutes AM PM AM/PM Friday Morning Start: Hours : Minutes AM PM AM/PM Friday Morning End: Hours : Minutes AM PM AM/PM Friday Afternoon Start: Hours : Minutes AM PM AM/PM Friday Afternoon End: Hours : Minutes AM PM AM/PM Saturday Morning Start: Hours : Minutes AM PM AM/PM Saturday Morning End: Hours : Minutes AM PM AM/PM Saturday Afternoon Start: Hours : Minutes AM PM AM/PM Saturday Afternoon End: Hours : Minutes AM PM AM/PM Is childcare required at the day home during school closures between September – June?*(Example: During professional development days, Spring Break, etc.) Yes No Indicate which school closures: Total hours of care permitted per day:* Is a schedule required?* Yes No Total hours of care required per month (estimate):* Part time (number of days) guarantee: Childcare Fees:Please enter a number from 0 to 9999.99.Day Home Educator’s Name: In-Home backup care individual:(if applicable) Name of School:* Grade:* School address:* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code School Phone number:*School Start time:* Hours : Minutes AM PM AM/PM School Dismissal time:* Hours : Minutes AM PM AM/PM It is the parent/guardian’s responsibility to arrange transportation for the child to and from school. Northalta and/or the Educator is not responsible/liable in the event the child does not arrive at the school or day home.Transportation method to and from school:* Bussing company Parent/guardian Educator Other method or person (such as grandparent, neighbor, friend, taxi, etc.) Bussing Company Name:* Bussing Company Phone Number:*Bus driver name:* First Last Bus driver’s phone number:*Is the child’s seatbelt buckled and unbuckled by the bus driver?* Yes No Note: When the bussing company requires the Educator to buckle the child in their seat, appropriate supervision of ALL day home children is required by the Educator.Will the child be transported in the Educator’s personal vehicle?* Yes No Name of authorized person:* First Last Phone number:*Relationship:* Name of authorized person #2 or method:* First Last Phone number:*Relationship:* Note: Person must be 18+ years old. Children cannot walk to school unsupervised/alone.If the child does not arrive at the day home by the scheduled time, the Educator should contact:* First Last Phone number:*Name:(if applicable) First Last Phone number:(if applicable)Additional Information:Consent*Disclaimer: Child Information Records • Records are available to parents at reasonable times and are available to CS at all times. • Records may be in paper or digital form. • Records must be kept by the Agency for a minimum of two (2) years. • Family day home programs must collect, use, and disclose personal information (for example, information pertaining to parents/guardians, children) in accordance with appropriate privacy legislation Freedom of Information and Protection of Privacy Act or Personal Information and Protection Act. Contract Information • The Agency/Parent contract is subject to amendment with thirty (30) days’ notice. • The parent/guardian will be notified via email of updates to Northalta policies and/or Children’s Services standards. • If a contract amendment is required, the parent/guardian is required to review the ‘Personal Information’ section only. The remainder of the contract will remain unchanged. • Parent/Guardian’s signature is required when the contract is amended. 1. The first thirty (30) days of childcare is a trial period commencing on a child's first day of care (excluding transition care). During this time either the parent/guardian or Educator may terminate the childcare agreement immediately. Note: The Trial month is applicable to first time registrations only. 2. Cancelled registrations will result in an Administration Fee. 3. Childcare fees are based on the days/hours indicated on the Agency/Parent contract. The childcare fee remains the same even if the contracted childcare hours are not used. This includes absenteeism due to illness and vacation. 4. The parent/guardian must inform the Educator when the child will be absent. Should an unexplained absence occur, the child may be assumed to be “a missing child”. This is a reportable incident to Children’s Services. 5. The parent/guardian will use the hours specified in the contract. Overtime payments are paid directly to the Educator the same day. 6. If a family has a part time contract, however, requires additional days of care, payment for the additional days is required prior to use. 7. When childcare exceeds 9.5 hours/day or uses Extended Hour Care (before 6:00a.m., after 6:00p.m. and/or Saturdays) the contract must be updated with the childcare hours. An increase in fees may apply. 8. If the parent/guardian is approved for the Extended Hour Care subsidy, a minimum of four (4) extended hours per month must be used. Fees NOT covered by subsidy are the parent/guardian’s responsibility. Payment Payment options include: • e-Transfer • Pre-Authorized Debit 1. The parent/guardian will be notified by email regarding changes to their childcare fee. 2. Childcare fees must be received in full, by the Agency, on or before the first (1st) business day of each month. 3. When childcare fees are subsidized by a third-party such as Children’s Services or Alberta Works, Northalta requires confirmation from the organization. Payment is due prior to the first (1st) business day of each month. 4. If childcare fees are not received by the third (3rd) business day of the month, a late fee is applied. 5. If childcare fees are not received by the fifth (5th ) business day of the month, childcare is suspended/terminated. 6. The Agency may terminate care immediately for non-payment. An additional fee equal to two (2) weeks in lieu of childcare will be applied. 7. An Administrative Fee will be applied to any N.S.F. (insufficient/returned) payments. 8. If the childcare account is sent to a Collection Agency, fifty (50%) of the total amount owing will be added to the account. The parent/guardian is responsible for paying all costs in full. 9. Northalta may release information collected to a third-party Collections Agency as outlined in the Freedom of Information and Protection of Privacy Act or Personal Information and Protection Act. Childcare Payment - Educator Availability 1. The parent/guardian is not required to pay for days the Educator is unavailable. 2. The parent/guardian may contact Northalta for backup care when the Educator is unavailable. If the parent/guardian reserves backup care, they pay for the space whether it is used or not. 3. Day homes are closed on Northalta approved statutory holidays. Childcare rates may vary based on a part time guarantee. Medical Information 1. If a child has a medical condition and/or allergy, a copy of the diagnosis is required by the Agency. 2. The parent/guardian will provide written instructions regarding the symptoms and treatment of the child’s medical conditions/concerns to Northalta, and the Educator. 3. If a child has been diagnosed/assessed with a special need or behavior, a copy of the diagnosis or assessment is required by the Agency. 4. If a child has a medical condition, the first sixty (60) days of childcare is a trial period commencing on a child's first day of care or from the date of diagnosis (excluding transition care). During that time either the parent/guardian or Educator may terminate the childcare agreement immediately. 5. If a child has dietary concerns, allergies, or medical concerns, the parent/guardian is required to supply the child’s food. 6. Northalta Educators have first aid training. They do not have medical training. 7. Northalta staff, Agency, and/or the Educator are not responsible, in any way, for any medical costs and/or complications related to a child’s medical condition. 8. The Educator can administer the child’s medication by completing a medication authorization form. 9. In an emergency, the Educator will contact the parent/guardian or emergency contact, and Northalta. 10. The parent/guardian may authorize any medical procedures deemed necessary by a doctor or other medical personnel. 11. The Educator and/or Agency may release child related information to medical personnel. Childcare Termination 1. The parent/guardian will provide thirty (30) days’ notice to terminate the Agency/Parent contract or pay for two (2) weeks in lieu of insufficient notice. Notice must be given to Northalta and the Educator. 2. The Agency provides thirty (30) days’ notice to terminate childcare services except for extenuating circumstances. 3. Extenuating circumstances include, but are not limited to, situations affecting the health, safety or wellbeing of a child or the Educator. Childcare may be terminated without notice. Additional Information 1. The Educator will provide a meal and snacks which follow the Canada Food Guide and Alberta Health recommendations. 2. If a child has cultural or personal preferences, or is not on table food, the parent/guardian is required to supply the child’s food. 3. The parent/guardian will supply appropriate indoor and outdoor clothing, change of clothing, sufficient diapers, cleansing wipes, and a non-porous change pad. Additional items may be requested by the Educator. 4. The Educator will use positive guidance. The Educator cannot administer corporal punishment such as spanking, verbal harassment, time-out, or physical restraints. 5. The parent/guardian will notify the Educator, and Northalta, of any changes in personal information and/or circumstances. (e.g.: address, phone number, employment, etc.) Additional proof of information may be required. (i.e.: copy of driver’s license, etc.) 6. I, the parent/guardian, received and understand the Family Day Home Program Profile, which records home visits, complaints received, and any incidents that may have occurred in the Educator’s Day home program. 7. I, the parent/guardian, have received, read and will comply with the policies in the Northalta Family Day Home Educator and Parent Manual. 8. Breach of this contract will result in immediate termination. By checking this box, I acknowledge and agree to the terms of the Agency/Parent – Child Attending School Contract.Name of Parent/Guardian:* First Last Parent/Guardian Signature:*Name of Parent/Guardian:(if applicable) First Last Parent/Guardian Signature:(if applicable)