Department of Public Welfare (DPW) AgreementYour Name*Email* Name of Child*Fee Amount*Per-Day-Week*Day Payment To Be Made*Services to be provided as part of the day care fee (examples; transportation, care, meals, etc. )*Child's Arrival Time* : Hours Minutes AMPM AM/PMChild's Departure Time* : Hours Minutes AMPM AM/PMPerson(s) Designated by Parent to Whom Child May Be Release*Late Fee*Per Min-HR*Extra services to be provided at an additional fee if applicableI, the parent / guardian* received complete written program information at the time of enrollment ( § 32.70.121, 3280.121, 3290.121 )I, the parent / guardian* agree to update the emergency contact / parental consent form information whenever changes occur or every 6 months at a minimum. ( § 32.70.124, 3280.124, 3290.124 )Signature*
