Day CareEnrollment Contract

Heroes’ Sunny Days Daycare Service

Enrolment Contract – 2015 – 2016

Last name of child: First name:

Date of Birth: Medicare #: Exp date:

Parent(s)/Guardian(s) Name(s):
Home Address:

Home Telephone: work: cell:
Email address: __________________________________________________________________

Parent(s)/Guardian(s) Name(s):
Home Address (if different):

Home Telephone: work: cell:
Email address: __________________________________________________________________

Child lives with: Both parent Mother Father Legal/Guardian
Joint custody: Yes No (if so, please provide custody calendar and an individual daycare contract for each parent using daycare.)

Individuals other than parent to contact in the event of emergency
Name: Relationship: Home: Cell:
Name: Relationship: Home: Cell:

Individuals other than parent allowed to pick-up child
Name: Relationship:
Name: Relationship:
Name: Relationship:

Does your child have any allergies or any serious health problems? Yes No
Type of reaction and/or problem:
Specific measures to take:

I would like to register my child as:
Regular Occasionnal Sporadic
Starting date (Obligatory):

Child will attend the following days:
Monday Tuesday Wednesday Thursday Friday
Monday am:______ Tuesday am:_______ Wednesday am:____ Thursday am:_____ Friday am:_____

The parent must give a 2 week notice to end their child’s use of the Daycare program, or to modify their existing contract. They will be responsible to pay for the current month fee or the total of the contract if failure in doing so.

Income Tax receipts
Name of person to receive tax receipt (payer):
Social Insurance Number:
I refuse to give the S.I.N. number: Signature:

Name of person to receive tax receipt (payer):
Social Insurance Number:
I refuse to give the S.I.N. number: Signature:

Please note that checks need to be made by the payer in order to receive the income tax receipt. If check is in another person’s name, that person becomes the payer. This is a government law. If paid in cash please indicate payer name on payment envelope.

I have read the attached “Daycare guidelines” and agree with all of its components (and daycare fees).

Name: Signature: Date