SRGhosh Family Childcare

64 Harrison Rd. Parsippany, NJ 07054
Phone: 973.455.7455 or 530.220.4249

Parent-Caregiver Agreement

Parent’s name: _____________________________   Child’s name: _____________________________   The purpose of this contract is to define the mutual terms of agreement for child care arrangements. It is your responsibility to let me (us) know of any changes of address or telephone and emergency numbers. Parents are welcome to visit any time.

Hours and Days of Operation
Child care services will begin on ____________________________________

The hours for care will begin at ______and end at ________on the following days: __________

If the child is going to be absent or late, please call in advance Child care will not be available on all legal holidays and week of thanksgiving.

I take a vacation each year for two weeks. I provide a qualified substitute when I am ill or have an emergency for which I have to be away from my home. The substitute will follow my schedule and conduct the child care service in my home.


$60 per week for full-time care (7 or more hours)
$8   per hour for regular part-time care (less than 4 hours)
$10 per hour for drop-in care if space is available
$1/min for late pick-up. This fee will be charged for any time after _______ unless special arrangements have been made.
$N/A per meal. Parents are required to bring the appropriate foods for infants under 12 months old.
Child care fees are payable in advance and are due no later than ____________. An additional fee of $25 will be charged if the payment is late. Fees may be paid:
                 Weekly _________     Bi-weekly ____X_____   Monthly ____________
An advance deposit of $100 must be paid at the time of enrollment. This amount will be returned when services are terminated.


Lunch will be brought by parents.
Snacks will be served:  ___________A.M ______________P.M __________LATE

Infants will be fed according to the parent’s instructions. Parents must update and notify caregiver of changes in feeding schedules, formulas and additional foods.

Medical Information

Your child is required to have a physical examination: ________ before admission in this child care program ______ each year while enrolled.

Please notify me (us) if your child will be absent because of illness.

Contagious disease must be brought to my (our) attention immediately. Medication will be administered only if there is a signed permission form from a licensed physician.

If you child becomes ill during care, you will be asked to pick up your child immediately. If you cannot reach, I (we) will call one of the emergency numbers you have listed. Your child will be readmitted when symptoms have subsided.


Your child’s clothing and other items must be labeled with his or her name and brought in some type of bag.

Parents will supply at least two complete sets of play clothes, outdoor clothing and the following:
_________disposable diapers       ________baby wipes           ________bibs
_________cloth diapers                ________training pants      ________plastic pants

We fully understand and agree to the terms of this contract.


Parent’s (s’) signature ______________________________________ Date __________________

Caregiver’s signature ______________________________________ Date __________________