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Get WA DSHS Child Care Agreement 2010

S my child will receive care: Check days of care Sunday Monday Tuesday Wednesday Thursday Friday Saturday Arrival time Departure time Fee: $ Hour Date payment due: per: Day Week Overtime rate: $ Other Fees: $ Month Source of payment: per Parent Other (specify): Late fee: $ per Description: I agree to promptly notify the child care provider of any changes of the above information. I understand that I am fully responsible for the terms of this agreement as stipulated. I have .

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