Child Care Contract for Enrollment
St. Paul’s Lutheran child Center 582-9745
695 Grant Street, P. O. Box 70, Winneconne, WI 54986
Child’s name: _____________________________________________________________________
(First) (Last) (Middle)
Home Phone: ________________________
Child’s Birth date______________ Sex: M F Cell Phone: _________________________
Cell Phone: _________________________
Parents’ names: __________________________________________________________________
(Mother) (Father)
Address: ________________________________________________________________________
(City) (Street, include PO Box) (Zip code)
Name of home congregation: ________________________________________________________
E-Mail where parent can be reached___________________________________________________
Home e-mail where we can send you information________________________________________
All fractions of an hour are rounded up to the next whole hour, for example 2.5 hrs. Of care will become 3 hours.
Discount Costs:
Below are the charges for each age group served. There will be a 7% discount for the second child and a 14% discount for the third child. Any additional hours will be at a $3.50 an hour rate.
My child needs care as follows (specify arrival/departure times):
Infant & Toddlers:
____Monday through Friday (5 Hrs) $140.00 Half Days: Times: __________ to __________
____Monday through Friday (10 Hrs) $200.00 Full Days: Times: __________to __________
Two’s:
____Full day childcare, up to 10 hours a day is $38.00 a day ($190.00 wk)
____Half-day childcare, 5 hours a day is $26.00 a day ($130.00 wk)
Times:
Monday: ______________ to ____________ Tuesday: __________ to __________
Wednesday: ____________to ____________ Thursday: __________ to __________
Friday: ________________ to _____________
Preschool Age:
____Half-day pre-school - 3 hrs, 8:00 AM to 10:45 AM - cost for first child $10.50 (wk $52.50)
____Half-day childcare - 5 hrs, (Example 6:30 AM to 11:30 PM or 7:00 am to noon) - cost for first child $17.50 (wk $87.50)
____Full-day Pre-school—7 hrs, 8:00 AM to 2:45 PM – cost for first child $24.50 (wk $122.50)
____Full-day childcare—10 hrs a day- (Example 6:30 AM to 4:30PM or 7:30 AM to 5:30 PM) cost for first child $35.00 (wk $175.50)
____Full Day/Full week childcare for 3 to 5 year olds will be discounted to $165.00 per week.
Monday: ______________ to ____________ Tuesday: __________ to __________
Wednesday: ____________to ____________ Thursday:__________ to __________
Friday: ________________ to _____________
(A.M. preschool classes 8:00-10:45, p.m. preschool classes 12:00-2:45 p.m.)
School Age:
____Before school care, 6:30 am to 7:45 am is $3.50 per day ($17.50 wk)
____Before and after school care 6:30 am to 7:45 am and 3:10 pm to 5:30 pm is $11.50 per day.
____After school care is $8.00 per day. ($40.00 wk)
____Summer Care or no-school days are $31.50 per day.
Drop In Care: For children not scheduled on a weekly basis.
___Drop in care is $6.00 an hour. Dates: __________, __________, __________, __________
Times: __________ to ___________
Any additional hours will be at a $3.50 an hour rate
This schedule of childcare to start on: ____________________ and end on: ___________________
Total due at beginning of each week = $__________
Registration Fees:
Registration fee (one time, non-refundable registration due with initial application only)
St. Paul’s Lutheran Church members $50/ nonmembers $100 $______________
Late fee: If child is not picked up by 5:30 p.m., there is a $1.00/minute per child charge to be paid by the first day of attendance in the next week.
Up to six vacation days and six sick days with no charge are allowed from July 1- June 30 of the next year. For vacation days, the director must be notified in writing at least one week in advance. If your child is sick, you can notify the director in writing of your intent to use a no-charge sick day or when you call to inform the center that your student is ill indicate that you would like to use a sick day. If you chose to use sick days as vacation days, you will be responsible for paying for any absences that occur.
I agree to abide by State of Wisconsin HFS 46 licensing rules and St. Paul’s Lutheran Child Center policies and procedures.
Parent’s signature: ____________________________________________ Date _________
