Children’s Cottage Child Care Inc.

Sign Up for Automatic Payments and Never Write a Check Again!

We need the following information on the checking account  (Or simply attach a voided check)

Bank:_______________   9 Digit Routing: ________________   Acct No:__________________

Debit $_______  once on the  (pick one)      ___1st of each month         ___5th of each month


Debit $                       twice on the (pick one)       ___1st & 15th of month      ___5th & 20th of month

Email Address So You Can Receive Monthly Statements & Information

Primary Person Name ____________________Email ____________________________________

Optional Secondary     ____________________Email_____________________________________

Images of the Children

We put pictures/videos of the children, teachers, or parents on our Website or Facebook Page.

Most parents love this because it gives them a chance to share pictures with family and friends.

If a parent or guardian does not want images of their child on our website or Facebook page,  

please give us a written note stating your wishes so that we may place it in your child’s folder.

Behavior Conduct Contract

I have read and understand the Behavior Conduct Contract in the Parent Handbook and agree to abide by its content

Teachers Performing Outside Work

If a Children’s Cottage employee performs work or services beyond their employment hours

for a parent or guardian, client or non-client of Children’s Cottage, it is understood and agreed

that the employee does not represent Children’s Cottage in doing this work or performing

these services and that Children’s Cottage is in no way responsible or liable for this work,

service, or the actions or behavior of the employee.  This includes babysitting, etc.

Parent/Guardian Signature_______________________ Date________