Master Enrollment - JDM Dayhome Agency

1. Registration Context & Guardians

Educator Name

Primary Language Spoken at Home

PRIMARY GUARDIAN

Full Name

Mobile Phone

Email Address

Home Address

SECONDARY GUARDIAN

Full Name

Mobile Phone

Email Address

Home Address

EMPLOYMENT & DAYTIME EMERGENCY CONTACT

If mobile phones are unreachable, the agency must have daytime work contact numbers on file for emergencies.

Primary Guardian Employer

Work Phone

Secondary Guardian Employer

Work Phone

Anticipated Schedule (Days)

Drop-off Time

Pick-up Time

3. Emergency & Authorized Contacts

Emergency Contact 1 (Non-Parent)

Phone

Relationship

Alternate Authorized Pick-ups

Custody Arrangements & Unauthorized Pick-ups

4. Financial Agreements & Policies

Late Payment Policy & Penalty Fee

A penalty fee of $50 CAD will be automatically applied if the parent's fee payment is 3 to 5 days late past the due date.

Strict Communication Policy: I agree to direct all daytime phone calls and non-emergency inquiries to the JDM Agency. I understand that for the safety and full-time care of the children, educators are not to be contacted on their personal cellphones during operating hours.

Financial Policy: I agree to the fee payment policies, payout dates, and the $50 CAD late payment penalty fee outlined above.

Illness & Exclusion Policy: I agree to keep my child home when sick (e.g., fever, vomiting, communicable diseases) and will strictly follow the agency's return-to-care timelines.

Guidance & Discipline: I acknowledge that I have read and agree to the agency's child guidance and discipline protocols.

Termination of Care: I understand the required notice period for withdrawing my child and my associated financial obligations.

5. Final Authorization

I affirm that the information provided for all children listed above is accurate.

Guardian Name (Printed)

Date