DCFS FORM: Late Pick up agreement

DCFS FORM

LATE PICK-UP AGREEMENT

The following agreement is made between ______________________and_________________________

Parents/Guardians                                                      Provider

____________for the pick-up of their child/children ___________________, ______________________

Name                                                                                   name           name

____________________, __________________, _ _______________ from the day care — home/group.

                        Name                                                           name                                                           name

I/we agree to pick up the above named child/children before ____________ he/she/they are in child care o'clock p.m. every day

If I/we fail to pick up my/our child/children by the appointed time, I/we understand that a late fee of ___________ per quarter hour (or portion thereof) will begin to accrue after the above stated pickup time.

If I/we fail, without notice, to pick up my/our child/children at the above stated time, or arrange for someone else to pick them up, the provider will make 3 attempts to contact me/us. If the provider is unable to contact me/us, the provider should contact the emergency person listed on the Application/Record of Child Information sheet, or person on the contingency list, to advise them my/our child/children are still in their care without notice from me/us. If, for any reason, there is no telephone service the provider will contact police to request assistance in contacting me/us or my/our emergency persons.

Provider agrees to keep my/our child/children for 1 hour after the above stated pick-up time, with late fees accruing, before contacting the local police and/or the Child Abuse Hotline if contact cannot be made with parents/guardians or emergency persons.

Provider will continue normal responsibilities for the child's protection and well being and agrees not to discuss your tardiness in arriving with your child/children beyond reassuring them you or someone known to them will be there soon to pick them up.

Parents/Guardians agree to advise provider immediately of any changes regarding their personal contact information, including addresses and phone numbers for home and work and cell phone numbers. Parents/Guardians also agree to provide immediate notice to the provider of any changes for their emergency contact or contingency persons.

______________________________________                           ______________________________________

Parent/Guardian                                                                                                                                  Provider A

______________________________________                           ______________________________________

Patent/Guardian                                                                                                                                  Provider B

______________________________________                           ______________________________________

Date signed                                                                                                                                             Date signed

This form meets the requirements of Rule 406.12(h), Rule 407.260(f) and Rule 408.60(j)

DCFS Form: Hazard protection plan

DCFS FORM

SAMPLE HAZARD PROTECTION PLAN

Identified Hazards:

Stairs: I have two sets of stairs. One set that leads to the second level and the other which leads to the basement. The stairs to the second level are gated denying access to children not allowing them to go upstairs by themselves. The stairs to the basement are inaccessible by a door which is secured with a latch high enough to prevent the children form unlocking the door.

Swimming Pool: 4 foot above-ground swimming pool will not be used at all by the Day Care children. The pool ladder is removed and the fence surrounding the pool is 6 feet high with a locked gate.

Neighbor's dog: Children will not be allowed to play on the side yard which adjoins to the neighbor's yard. All children will be supervised by and adult while outside.

Trampoline: Trampoline will not be used at all by day care children. All children will be supervised by an adult while outside.

Fireplace: The fireplace in my home will not be used during day care hours.

Outside Play Area: Children will play outside in fenced backyard. They will be supervised at all time while playing outside.

Travel to nearby parks: From time to time, I will take the children to a park in the neighborhood. I will walk them safely on the sidewalk and prevent them from crossing the street without me walking with them. They will be closely supervised at all times while walking to and from the park, as well as being at the park

Traffic: Parents will be expected to come into the house to pick up and drop off their children.

Tools: All tools, gardening and otherwise, are locked in the garage and inaccessible to the children in my day care.

Medicine: Medicine is locked and stored out of the reach of the children.

Cleaning Supplies: Cleaning Supplies are locked and stored out of the reach of the children.

Radon Testing completed at least once every 3 years.