Everything We Need, In One Easy Place to Fill

Please complete the forms below so we can welcome your child into a safe, loving, and educational environment. Every section mirrors our official paperwork — fill it in, print it, or save it for your records.

Application Form

Step 1 - Home Daycare Agreement
Step 2 - Child Enrollment Form
Step 3 - Written Permission Form
Step 4 - Daycare Contract
Step 5 - Child Illness Policy
Step 6 - Child Care Incident Log
Step 7 - Parent / Provider Acknowledgment

HOME DAYCARE AGREEMENT

This agreement is made and entered into by and between the Parent(s) / Guardian(s) and the Child Care Provider.

1- The Parties

Agreement Date

Parent(s) / Guardian(s)

City / State

Provider Mailing Address

Child Care Provider

City / State

Mailing Address

2- The Children

Child 1 — Name

Date of Birth

Child 2 — Name

Date of Birth

Child 3 — Name

Date of Birth

3- Term

Commencement Date

Commencement Agree Options

At-Will — with written notification of at least 14 days' notice

Terminates on a fixed date:

Termination Date

4. Child Care Services

The Child Care Provider agrees to supply the necessary daily care to the Child(ren), including but not limited to constant supervision, social engagement, age-appropriate activities, and promoting good behavior — hereinafter the "Child Care Services."

5. Weekly Schedule

Monday Schedule

Tuesday Schedule

Wednesday Schedule

Thursday Schedule

Friday Schedule

Saturday Schedule

Sunday Schedule

Late Pick-Up & Overtime

If the Parent(s) are going to be late picking up their child(ren), every effort must be made to contact the Child Care Provider. After the pick-up time, the Parent(s) shall be responsible for the applicable late pick-up fee.

Overtime care (with approval), per hour

Overtime care (without approval), per hour

6. Holidays — Provider Unavailable On

Holidays — Provider Unavailable On

New Year's Day

Memorial Day

Columbus Day

Christmas Day

Martin Luther King Jr. Day

Independence Day

Veterans' Day

President's Day

Labor Day

Thanksgiving

7 & 8. Payment Amount & Method

Services amount, per child

Billed per

Hour

Day

Week

Month

Payment shall be made

Daily

Weekly

Bi-Weekly

Monthly

Other

9. Deposit

Deposit Fields

Required — deposit amount $ (applied toward damage or unpaid balances; if repayment is required it is returned within 5 business days after termination)

Not required to pay a deposit before services begin

Required Amount To Be Deposit

10. Absence

Notice required (days)

Charge for absent day(s) with proper notice

Without proper notice, the Parent(s) shall be charged the full amount as if Child Care Services had been provided.

11. Vacation Times

Vacation Fields

Parent(s) Vacation — at least day(s) notice. During vacation, payment is required / not required

Child Care Provider Vacation — at least 7 day(s) notice before going on vacation

12–13. Damages, Governing Law, Severability & Entire Agreement

If any child, while under the Child Care Provider's supervision, causes damage to the premises other than normal wear and tear
Wear and tear, the Parent(s) shall be responsible for repairing the damage.
This Agreement is governed by and construed in accordance with the laws of the State of Connecticut.
If any term, covenant, condition, or provision is held invalid, void, or unenforceable, the remainder shall remain in full force and effect.
This Agreement constitutes the entire agreement between the Parties, superseding prior understandings, except as otherwise agreed in writing. No supplement, modification, or amendment shall be binding unless executed in writing by All Parties.

Signatures

Parent(s) Signature

Date / Time

Child Care Provider's Signature

Date / Time

Child Enrollment Form

This information must be kept current at all times and is retained on file for one year after the child ceases to be enrolled.

Date of Application

Date of Enrollment

Last Day of Enrollment

Child Information

Child's Name

Date of Birth

Child's Address

City

Zip Code

Parent / Guardian 1

Name

Address

City

Zip Code

Home Telephone

Cell

Emergency Contact

E-mail Address

Employer

Work #

Employer's Address

City

Zip Code

Parent / Guardian 2

Name

Address

City

Zip Code

Home Telephone

Cell

Emergency Contact

E-mail Address

Employer

Work #

Employer's Address

City

Zip Code

My Child's Weekly Child Care Schedule

Monday Schedule

Tuesday Schedule

Wednesday Schedule

Thursday Schedule

Friday Schedule

Saturday Schedule

Sunday Schedule

Signature of Parent or Guardian

Date

Written Permission Form

Please keep this information current, and carry a copy of this form during any off-premises activity.

Child Information

Child's Name

Child's Date of Birth

Child's Address

City / Zip Code

Authorized Persons — May Remove Child

Name

Phone #

Relationship

Address / City / Zip

Name

Phone #

Relationship

Address / City / Zip

Emergency Release Contacts

Adults to be contacted if the parent cannot be reached and to whom the child can be released:

Name

Phone #

Relationship

Name

Phone #

Relationship

Address / City / Zip

Emergency Medical Care Providers

Provider / Facility

Phone #

Address / City / Zip

Child's Physician

Phone #

Address / City / Zip

Child's Dentist

Phone #

Address / City / Zip

Parent / Guardian Authorization

Checkbox Field

Transport child for activities away from the family child care home

Allow child to participate in activities away from the child care home

Transport child in an emergency to a medical provider, physician, dentist, or other facility

Include child in swimming when recreational swimming is part of the program

Arrange school transitioning, including transportation, bus locations, and supervision

I understand that I must provide written permission and instructions specifying these arrangements. The provisions outlined on this form have been worked out in consultation with me and my family child care provider.

Signature of Parent or Guardian

Date

Daycare Contract

This Agreement is made and entered into by and between the Provider and the Parent / Guardian.

Agreement Date

Name

Phone

Address

Parent / Guardian & Child

Parent / Guardian Name

Child's Name

Child's D.O.B.

Additional Child

Services Provided

Days of Care

Hours

Rate $: Per Hour/Day/Week

Payment Due

Payment Schedule

Weekly

Bi-Weekly

Monthly

Other

Payment Method

Cash

Check

Bank Transfer

Other

Policies & Agreements

Drop-off / Pick-up: Must be on time. A late pickup fee applies per the rate agreed with your provider.
Illness: Child must be fever-free for 24 hours without medication.
Vaccinations: Up-to-date records required (unless exempt).
Supplies: Parent provides diapers, wipes, change of clothes, etc.
Termination: Either party may terminate with the agreed notice period.

Late pickup fee $: Per Hour/Day/Week

Termination notice (days)

Authorization & Consent

Medical Emergency — permission to seek medical treatment if parent is unreachable

Yes

Photo Release — permission for daycare updates/advertising

Yes

Additional Terms

Any additional terms both parties agree to...

Provider Signature

Date

Parent/Guardian Signature

Date

Child Illness Policy

Your child's health and safety is our first priority at Titine Blessing Child Care LLC.

In order to maintain a safe and healthy environment and prevent the spread of illness, we have established the illness policy below. If your child has any of the symptoms listed, please keep him or her home and notify the daycare. Your child may not return until symptom-free for at least 24 hours, unless otherwise directed by a healthcare professional or applicable regulation. If your child becomes ill while in daycare, you will be contacted immediately so that he/she can be picked up.

Symptoms Requiring Exclusion / Pick-Up

Fever of 100.4°F or greater
Vomiting
Diarrhea
Positive COVID, flu, strep, or other communicable disease test
Unexplained rash or hives
Persistent cough (not allergy-related)
Excessive and/or persistent mucus from the mouth, nose, or eyes

Ear drainage or severe earache; suspected or confirmed ear infection
Eye infection or suspected eye infection
Difficulty breathing or wheezing
Oozing sores or cuts
Moderate to severe headache
Head lice or ringworm (until treated)
Unexplained fatigue

Parent / Guardian Acknowledgment

Please sign and date, indicating your understanding of this policy.

Printed Name

Date

Signature

Date

Printed Name

Date

Signature

Date

Received By

Received On

Child Care Incident Log

This log records accidents, DCF-reportable incidents, observations, injuries, illnesses, unusual behaviors, and important discussions with parents. It is shared with the parent(s) no later than the next business day.

Repeater Container

Child's Name

Date

Time & Location

Person(s) Present

Description / Action Taken / Parent Notification

Provider Initials / Signature

Date

Parent / Provider Acknowledgment

By signing below, the undersigned acknowledges that they have received and reviewed the applicable child care forms and policies, and that the information supplied is accurate to the best of their knowledge.

Documents Reviewed

Home Daycare Agreement & Schedule

Written Permission Form

Child Illness Policy

Child Enrollment Form

Daycare Contract

Child Care Incident Log Procedures

Parent / Guardian

Printed Name

Date

Signature

Phone / Email

Child Care Provider

Printed Name

Date

Signature

Phone / Email

Additional Notes

Anything else worth noting...

Frequently Asked Questions

Have questions about our childcare services? Find answers to the most common questions about enrollment, transportation, meals, overnight care, and more.

What ages do you accept?

We welcome children of different ages and provide personalized care tailored to their individual needs and stages of development. Through age-appropriate learning activities, creative play, and a nurturing environment, we help every child learn, grow, and build important life skills.

Do you provide meals and snacks?

Add more power to Elementor using our creative elements and make your projects look prettier than ever before.

Do you offer overnight childcare?

We strive to innovate when it comes to functionality. Our mission is to be the best, come and join the ride.

Do you accept the Care 4 Kids program?

Each and every one of our customers receives personalised assistance from our dedicated support team.

What Parents Are Saying

We are proud to earn the trust of families who rely on us every day. Read what parents have to say about our caring staff, quality childcare services, and the safe, nurturing environment we provide.

Sarah M.

The staff is incredibly caring and attentive. My child loves the activities, and I have complete peace of mind knowing they're in a safe environment.

Jessica R.

The transportation service and healthy meals have made our daily routine so much easier. I highly recommend this childcare center to any family.

Amanda T.

From the friendly teachers to the engaging learning programs, everything has exceeded our expectations. My child looks forward to coming here every day.