Kaleidoscope Kollege · Service Agreement

Enrollment
Contract

Please complete all sections below. A 20% down payment is required to secure your child's enrollment. The remaining balance is due on the day services are rendered. All fields marked are required.

Section 1

Parent / Guardian Information

Full Name *

Street Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

Section 2

Client Information

Child's Full Name *

Date of Birth *

Section 3

Payment Type

Select Payment Type *

InsurancePrivate Pay

Section 4

Services Requested

Select All That Apply *

Infant & Toddler Care (Ages 0–3)

Pre-K Program (Ages 3–5)

Part-Time / Flexible Care

Virtual In-Home Learning

Toiletry Package Add-On

Early Drop-Off (Before 6am)

Late Pick-Up (After 5pm)

Overnight / Weekend Care

Requested Start Date *

Additional Notes / Special Requirements

Section 5

Child Health & Accommodations

Please disclose any special needs, allergies, medications, or accommodations your child may require during care. This information is kept confidential and used solely to ensure your child's safety and wellbeing.

My child has special needs or a developmental consideration

My child has allergies (food, environmental, or other)

My child requires prescription medication during care hours

My child requires additional accommodations or has other health considerations

Section 6

Payment Options & Terms

Preferred Payment Method *

Down Payment — 20%

A non-refundable down payment of 20% of the total services amount is required to secure your child's enrollment. This payment must be received before services begin. The down payment is applied toward your balance.

I understand and agree that a 20% non-refundable down payment is required to secure enrollment.

Balance Due — Day of Service

The remaining balance (weekly rate minus down payment) is due in full on the day services are rendered. Failure to pay the balance on the day of service may result in suspension of care.

I understand that the remaining balance is due on the day services are rendered.

Section 7

Agreement & Signature

By signing below, I, the parent or legal guardian, confirm that all information provided is accurate and complete. I agree to the payment terms outlined in Section 5, including the 20% non-refundable down payment and the balance due on the day of service. I authorize Kaleidoscope Kollege In Home Learning & Daycare to provide the selected services to the named client. I understand that this agreement is binding upon submission.

Print Full Name (Signature) *

Date *

I have read, understood, and agree to all terms and conditions of this service agreement with Kaleidoscope Kollege In Home Learning & Daycare.

Ready to Submit?

Review all sections before submitting. Once submitted, our team will contact you to confirm enrollment and collect the 20% down payment.

EnrollmentContract