Application Form

Child’s Identifying Information (optional information, for emergency use only):

Parent/Guardian’s Information:

Emergency Contacts Information:

Parent’s Marital Status: Married / Divorced / Separated / Widow / Single

Guardianship Status: Guardian / Foster Parent (s)

Operating Information:

Location: 505 Queenston Rd., Hamilton ON L8K 1J6

Operating Hours: Monday – Friday 7:00am – 5:30pm (We may offer extended care from 6:00 am and pick up until 6:30 pm. This will incuran additional $5 per 1/2hour charge if extended care is needed)

AM & PM snacks are provided each day. You are responsible to provided breakfast and any extra snacks daily. (A lunch menu guide is provided for parents who choose to have lunch provided daily).

Rate/Compensation:

Daily rate @ $60 p/d for full-time 12 months and over. $75 per day for under 12 months $65p/d for part-time (min. 3 days per week required) and $45p/d half days. $75 per day for drop in service. Summer daycamp rates are $150 per week. Before and after school rates are $15 per hour and tutoringservices are $20 per hour. All rates are subjected to change (s) with 2 weeks notice given. Monthly payments are due on the 1st of the month with 2-5 days grace period. Bi-weekly payments are due on the 1st and 15th of the each month with 2 days grace. Payment methods are: Cash/Email transfer/certified bank draft or cheque/ bank deposit (acct details may be provided). You may also pay thru the daycare app by credit/debit card or PayPal.

Health/Safety/Outdoor Play:

• All area of the property except the basement (storage)are identified as the areas that the children will play, learn and sleep. All meals are eaten at a designated eating area under the watch of a caregiver.
• Changing and handwashing will take place in the designated daycare changingroom/ washroom. If your child is soiled, they will be bathed in the designated daycare shower.
• All plugs outlets are covered throughout the daycare area. Access to the all stairs and kitchen area will be block with gates.
• Daily outdoor times will be mainly in the fenced backyard. Indoor play with creative/TV programs for the extremely cold/rainy days and short walks to the park and/or backyard on warmer days (park days are at least 1 day per week).
• Six Emergency Exits are identified as the main daycare entrance/exit front door, the front bay window (openings on either side), the sleeping room window, the connecting door to the main house, the back sliding door and and the main front door. Carbon monoxide/smoke alarm throughout the entire daycare designated areas.

Medication/Illness/Liability Insurance

Please inform us of any medications that your child is taking, allergies, past illnesses (a doctor’s form will need to be filled out during the first 6-8 weeks of being at the daycare). An up to date immunization record is also required with this application.

-Please leave a copy of you child’s health card for emergency purposes and any medications and instructions w/the caregiver.

-We are not responsible if your child becomes ill and we were not informed of any illness/allergies/genetic disorders/etc…

-Parents/Guardians/Emergency contacts will be immediately contacted in case of any emergency concerning your child.

We will endeavour to ensure that your child is safe at all times but cannot safe guard against all circumstances as there may be an instance where God forbid an emergency situation may take place with your child. We will first call 911 and then call you, no responsibility will be taken and you agree to waive your rights to any form of litigation and or lawsuit. We are not covered by any insurance company from any loss or liability and therefore will not be responsible for any loss of possessions, any illnesses, life, deformity or anything else that may happen including any Acts of God. You may choose at anytime to purchase a separate insurance plan for you child/ren to insure the above noted.

I/we understand what was read and I/we agree:

Payment and Deposit

If payments are being made monthly, they are due on the 1st of each month, bi-weekly payments are due on the 1st and 15th of each month and weekly payments at the start of each week. A (1-5) days grace period may be given to make payment (s) in full. Failure to make payments in a timely manner will incur interest charges of 10% per week. Failure to pay after 30 days will be automatic cancellation of services. Balance outstanding (incl interest) after cancellation must be paid in full within 60 days. (Payments can be made in cash, cheque, money order, or email transferred to futurefamilycare@gmail.com)

Cancellation and Termination Policy (please read carefully)

You are locked in this agreement for a minimum of 12 months. If you choose to terminate before 12 months, you are liable to pay for the full 12 months. Post (after) 12 months; you are required to give a minimum of thirty (30) days verbal/written notice prior to cancellation or termination of services. You may choose to use your damage deposit towards a portion of your final payment, as long as an acceptable termination notice has been given and no major damage has occurred.

Missed Day/Vacation Days/Sicks Days

Missed Days: Payments are still required if children are absent for whatever reason including appts days off, family events, visiting other family, public holidays, etc… Vacation days: May be pro-rated with a minimum of two (2) weeks notice with the number of days missed to be deducted from the next payment cycle. Sick Days: If your child(ren) is sick please inform w/at least 24 hours notice prior to arriving at the nursery/daycare. Child(ren) with coughs, colds, fevers, any contagious illnesses cannot enter daycare space and will asked to stay home until they are better along with a doctor’s note before they can return. All payments will be prorated after the third day(3rd) of absence with an illness and a sick note must accompany the child upon their return. (See Forms and Documents on the Daily Connect App for further information on Sickness Policy)

All vacation/Sick days/Appts for caregivers will not affect your child (ren) attending this daycare.

By signing this policy, I acknowledge that I accept this policy and its terms.

Future Kidz Academy Additional Information Form