Parent Name(s): _______________________________________
Child’s Name: __________________________________
Date holding begins: ________________________

Holding Fees for Child:
_____ I agree to pay _____________________ (half normal rate) to hold my child’s spot from now until my child begins attending ******xx Childcare.
_____ A registration fee of $100 will be paid with my first payment.

*No refund will be given if we choose not to have our child attend.

Expected Child Care Start Date: _____________________________

Childcare Plans:
_____ Child will start full time at a rate of $__________ per month.
_____ Child will start part time at a rate of $______ per month




Parent/Guardian: __________________________________ Date: _____________
Parent/Guardian: __________________________________ Date: _____________
Childcare Provider: ________________________________ Date: ______________

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