Community Care License No. 376622451

Healthy Toddlers Care

Parent Contract & State Mandate Forms

4026 Olympic Street · San Diego 92115 · 619-582-4557

This packet includes the Parent Contract and all required state mandate forms (LIC 282, LIC 627, LIC 700, LIC 995, and AB 495 Family Preparedness). Please review and sign each form below before submitting.

Healthy Toddlers Care Parent Contract

Child Enrollment Information

Child's Full Name

Date of Birth

Start Date

Immunization RecordsRequired for Enrollment

Please upload a clear photo or PDF copy of your child's current immunization records. This is mandatory for student enrollment and must be on file before your child's start date.

Click to upload immunization record

PDF, JPG, or PNG · up to 10MB

Rates & Contracted Days

Full-Time (Mon–Fri) Childcare

Infant Care (0–24 months)$425/week

Toddler Care (2–5 yrs.)$375/week

School Age Care (6+ Years)$300/week

Part-Time — Infant Care (0–24 months)

Part Time 3 Days — Mon, Wed & Fri$300/week

Part Time 2 Days — Tues & Thurs$250/week

Part Time 2 Days — Mon & Wed$250/week

Part-Time — Toddler Care (2–5 yrs.)

Part Time 3 Days — Mon, Wed & Fri$250/week

Part Time 2 Days — Tues & Thurs$200/week

Part Time 2 Days — Mon & Wed$200/week

Part-Time — School Age Care (6+ Years)

Part Time 3 Days — Mon, Wed & Fri$200/week

Part Time 2 Days — Tues & Thurs$150/week

Part Time 2 Days — Mon & Wed$150/week

Drop-in / Daily Rates

Drop-in — Infant Care (0–24 months)$150/day

Drop-in — Toddler Care (2–5 yrs.)$100/day

Drop-in — School Age Care (6+ Years)$75/day

Registration Fee: A one-time, non-refundable registration fee of $100 is required upon enrollment to secure your child's spot.

Payment Schedule

Please select your preferred payment schedule:

Monthly — On the 1st of the month

Bi-weekly — On the 1st and 15th of the month

Weekly — Every Monday or Friday. If paying on a Friday, the payment is for services to be provided the following week.

Please note that payment must be completed before services can begin.

Reminder: Monthly tuition is based on a 4-week schedule. In 5-week months, auto-pay (monthly/bi-weekly) does not cover the extra week. Please submit payment for the 5th week manually. (Weekly payers are unaffected.)

Acknowledgment: I understand that if I am on a monthly or bi-weekly payment schedule, it is my responsibility to manually pay for the additional week during 5-week months.

Initial:

Total Amount You Will Pay Per Month

Parent Agreement

By signing this contract, I confirm that I have read and reviewed the entire Healthy Toddlers Care Parent Handbook, which includes all program information, policies, and procedures. I/we agree to all terms outlined within it and will initial each section to confirm my understanding.

Operating Hours

Healthy Toddlers Care operates from 7:30am to 5:30pm, Monday through Friday. Parents must drop off students by 9:00am. Parents may pick up students either by 2:00pm (before nap time) or anytime after 4:00pm (after nap time) so they do not disrupt student rest.

Initial:

Late Arrival Policy

Children arriving more than 15 minutes past their scheduled drop-off time without prior notification may be marked as absent. Persistent late arrivals may result in a review of enrollment.

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Tuition

Tuition is a flat fee and will not be prorated during holidays, school breaks, or if my child is absent due to sickness, family vacations, or any other reason.

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Payment Terms

I understand and agree that payments must be received before services begin. I am responsible for making payments on the contracted days/dates and for the agreed-upon amount each month. Acceptable payment methods: Zelle, Apple Pay, or directly via the Procare app.

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Late Payment Fees

A late payment fee of $25 will be assessed if tuition is not received by the grace period deadline. Continuous late payments may result in suspension or termination of services.

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Photo Sharing Policy

I/We grant permission for Healthy Toddlers Care to take photos/videos of my child for educational purposes, internal records, and occasional sharing on secure platforms/social media for promotional purposes.

Yes

Initial:

Your Child's Medical History

To ensure your child's safety and well-being, please list any known medical history or allergies:

If my child has allergies or a health condition it is mandatory to submit a signed note from a licensed medical doctor.

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Health & Illness Policy

Children who are ill with a fever, vomiting, diarrhea, or contagious illness must be kept home. They may return after being symptom-free for 24 hours without medication.

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Medication Administration

All medication must be prescribed by a physician, in its original container, and accompanied by a signed "Medication Administration Form." Over-the-counter medication requires a doctor's note.

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Emergency Procedures

In case of a medical emergency, Healthy Toddlers Care will contact parents/guardians immediately. If unreachable, emergency services will be called, and staff will act according to the child's emergency contact information.

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Pick-Up Authorization

Only individuals listed on the authorized pick-up form will be permitted to pick up the child. Photo identification will be required. Any changes must be provided in writing.

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Student Withdrawals/Termination

Written notification of termination is required to cancel my contract with Healthy Toddlers Care. My child may withdraw at any time, but I will be charged for two weeks tuition from the date that Healthy Toddlers Care receives the written notice of termination. I am aware that Healthy Toddlers Care reserves the right to terminate my child's enrollment at any time.

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Communication

Parents agree to maintain open and respectful communication with staff regarding their child's needs, development, and any concerns.

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Behavior & Discipline

We employ positive guidance techniques. Parents agree to support our behavior management strategies and discuss any persistent behavioral challenges with staff.

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Personal Belongings

Parents are responsible for ensuring their child brings appropriate labeled clothing, comfort items, and supplies. Healthy Toddlers Care is not responsible for lost or damaged personal items.

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Holidays & Closures

The center will be closed on designated national holidays and for staff development days, as outlined in the annual calendar. Tuition is not adjusted for these closures.

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Dietary Needs & Restrictions

Please provide any dietary restrictions or special food requirements your child has. This section is for preferences, not allergies (e.g., no meat or vegetarian).

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Change of Information

Parents are responsible for immediately notifying Healthy Toddlers Care of any changes to contact information, emergency contacts, medical conditions, or other relevant family details.

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Termination of Care by Provider

Healthy Toddlers Care reserves the right to terminate care with written notice for reasons including, but not limited to, non-payment of fees, repeated late pick-ups, or inability to meet the child's needs.

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Governing Law

This contract shall be governed by and construed in accordance with the laws of California.

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Severability

If any provision of this contract is found to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this contract shall otherwise remain in full force and effect.

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Entire Agreement

This contract represents the entire agreement between Healthy Toddlers Care and:

superseding all previous agreements and understandings.

Initial:

Signature

By signing below, I/we acknowledge that I/we have read, understood, and agree to all the terms and conditions outlined in this Parent Contract with Healthy Toddlers Care.

Parent/Guardian Name

Date

Parent/Guardian Signature (draw with mouse or finger)

Sign here

4026 Olympic Street · San Diego 92115 · 619-582-4557
State of California – Health and Human Services Agency · Community Care License No. 376622451

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES

AFFIDAVIT REGARDING LIABILITY INSURANCE

FOR FAMILY CHILD CARE HOME

SECTION A:

I/We, the parent(s)/guardian(s) of

acknowledge that BRIDGETTE MOSS, the licensee of HEALTHY TODDLERS CARE, has informed me/us that this facility does not carry liability insurance or a bond in accordance with standards established by Family Child Care statute.

SECTION B: To be completed only if licensee does not own premises or the licensee is a member of a condominium or Homeowner's Association.

I/We, the parent(s)/guardian(s) of ___________________________, acknowledge that BRIDGETTE MOSS, the licensee of HEALTHY TODDLERS CARE, has informed me/us that she/he does not own the premises or is a member of a condominium or Homeowner's Association, and the liability insurance, if any, of the owner/Homeowners' Association may not provide coverage for losses arising out of, or in connection with, the operation of the family child care home, except to the extent that the losses are caused by, or result from, an action or omission by the owner/Homeowners' Association, for which the owner/Homeowners' Association would otherwise be liable under the law.

Signature of Parent(s)/Guardian(s)

Sign here

Date

NOTE: The law requires Family Child Care providers to carry liability insurance or bond in the amount of $300,000 annually or to maintain this signed statement in the facility file. Lack of a bond or insurance does not affect the right of parents to bring legal action against the facility.

LIC 282 (8/08)

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CONSENT FOR EMERGENCY MEDICAL TREATMENT

Child Care Centers Or Family Child Care Homes

AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO BRIDGETTE MOSS – HEALTHY TODDLERS CARE TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR

THIS CARE MAY BE GIVEN UNDER WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE CHILD NAMED ABOVE.

CHILD HAS THE FOLLOWING MEDICATION ALLERGIES:

Date

Parent or Authorized Representative Signature

Sign here

Home Address

Home Phone

Work Phone

LIC 627 (9/08) (CONFIDENTIAL)

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

IDENTIFICATION AND EMERGENCY INFORMATION

CHILD CARE CENTERS/FAMILY CHILD CARE HOMES

To Be Completed by Parent or Authorized Representative

Child Information

Last Name

Middle Name

First Name

Sex

Date of Birth

Telephone

Street Address

City

State

Zip

Father's/Guardian's/Father's Domestic Partner's Information

Last Name

Middle Name

First Name

Business Phone

Home Phone

Home Address

City

State

Zip

Mother's/Guardian's/Mother's Domestic Partner's Information

Last Name

Middle Name

First Name

Business Phone

Home Phone

Home Address

City

State

Zip

Person Responsible for Child

Full Name

Home Phone

Business Phone

Additional Persons Who May Be Called in an Emergency

Name 1

Address

Phone

Relationship

Name 2

Address

Phone

Relationship

Name 3

Address

Phone

Relationship

Physician or Dentist to Be Called in an Emergency

Physician

Address

Medical Plan & #

Phone

Dentist

Address

Medical Plan & #

Phone

If physician cannot be reached, what action should be taken?

Call Emergency Hospital

Other

Names of Persons Authorized to Take Child from the Facility

(Child will not be allowed to leave with any other person without written authorization from parent or authorized representative)

Name 1

Relationship

Name 2

Relationship

Name 3

Relationship

Name 4

Relationship

Time Child Will Be Called For

Date

Signature of Parent/Guardian or Authorized Representative

Sign here

TO BE COMPLETED BY FACILITY DIRECTOR/ADMINISTRATOR/FAMILY CHILD CARE HOMES LICENSEE

LIC 700 (8/08) (CONFIDENTIAL)

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION

CHILD CARE CENTER
NOTIFICATION OF PARENTS' RIGHTS

PARENTS' RIGHTS

As a Parent/Authorized Representative, you have the right to:

Enter and inspect the child care center without advance notice whenever children are in care.
File a complaint against the licensee with the licensing office and review the licensee's public file kept by the licensing office.
Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years.
Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.
Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order.
Receive from the licensee the name, address and telephone number of the local licensing office.
Licensing Office Name: CDSS-CCKD Child Care Division MVRO
Licensing Office Address: 7575 Metropolitan Dr. #100 San Diego, CA 92108
Licensing Office Telephone #: 619-767-2200
Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office.
Receive, from the licensee, the Caregiver Background Check Process form.

NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE POSES A RISK TO CHILDREN IN CARE.

Acknowledgement of Notification of Parents' Rights

(Parent/Authorized Representative Signature Required)

I, the parent/authorized representative of

, have received a copy of the "CHILD CARE CENTER NOTIFICATION OF PARENTS' RIGHTS" and the CAREGIVER BACKGROUND CHECK PROCESS form from the licensee.

HEALTHY TODDLERS CARE

Name of Child Care Center

Signature (Parent/Authorized Representative)

Sign here

Date

NOTE: This Acknowledgement must be kept in child's file and a copy of the Notification given to parent/authorized representative.
For the Department of Justice "Registered Sex Offender" database, go to www.meganslaw.ca.gov

LIC 995 (9/08)

STATE OF CALIFORNIA — HEALTH AND HUMAN SERVICES AGENCYASSEMBLY BILL 495 · FAMILY PREPAREDNESS PLAN ACT

FAMILY PREPAREDNESS PLAN

Emergency Preparedness & Family Privacy

In accordance with California AB 495, all families must complete this form so we have an exhaustive list of your chosen emergency contacts and clear instructions on who is authorized to care for your child if you are temporarily unavailable. We do not collect or store information regarding the immigration or citizenship status of our families.

Student Information

Student Full Name

Date of Birth

Parent / Guardian 1

Full Name

Phone Number

Email Address

Home Address

Parent / Guardian 2 (if applicable)

Full Name

Phone Number

Email Address

Home Address

Tiered Emergency Contacts

We will contact these individuals in order before reaching out to any outside agency. All three are required.

Emergency Contact #1

Full Name

Relationship

Phone Number

Emergency Contact #2

Full Name

Relationship

Phone Number

Emergency Contact #3

Full Name

Relationship

Phone Number

Long-Term Care Designee (24+ hrs)

"If I am unable to be reached for more than 24 hours, I authorize the following person to pick up my child and provide temporary care on my behalf."

Full Name

Relationship

Phone Number

Address

By typing your name below, you confirm that all information provided is accurate and current for the 2026 school year, and that you authorize Healthy Toddlers Care to use this information in accordance with California AB 495.

Signature (draw with mouse or finger)

Sign here

Date

Typed name serves as electronic signature.

AB 495 — Family Preparedness Plan Act

Contract Submission

Before submitting: Every line and field across all forms in this packet (Parent Contract, LIC 282, LIC 627, LIC 700, LIC 995, and AB 495) must be completed with the requested information, or marked N/A or None. A packet with any blank required lines cannot be submitted.

Please complete all fields, initial every Parent Contract section, and sign every form above before submitting.

4026 Olympic Street · San Diego 92115 · 619-582-4557
State of California – Health and Human Services Agency · Community Care License No. 376622451

Healthy Toddlers Care

Healthy Toddlers Care Parent Contract

Child Enrollment Information

Immunization RecordsRequired for Enrollment

Rates & Contracted Days

Payment Schedule

Parent Agreement

Signature

AFFIDAVIT REGARDING LIABILITY INSURANCE

FOR FAMILY CHILD CARE HOME

CONSENT FOR EMERGENCY MEDICAL TREATMENT

Child Care Centers Or Family Child Care Homes

IDENTIFICATION AND EMERGENCY INFORMATION

CHILD CARE CENTERS/FAMILY CHILD CARE HOMES

CHILD CARE CENTERNOTIFICATION OF PARENTS' RIGHTS

PARENTS' RIGHTS

Acknowledgement of Notification of Parents' Rights

FAMILY PREPAREDNESS PLAN

Emergency Preparedness & Family Privacy

Contract Submission

CHILD CARE CENTER
NOTIFICATION OF PARENTS' RIGHTS