Althea Penn, Educational/Licensing
Consultant
Telephone: 678.557.8684
E-mail: penntraining@yahoo.com
Website: http://altheapenn.tripod.com
Client Information and
Service Agreement
Name of
Owner or Corporation |
Mailing
address (city/zip/county) |
Site
Address (city/zip/county) |
Daytime
telephone
Facility telephone |
Email
address |
Legal
Contact Person |
Facility
Landlord’s Name |
Facility
Landlord’s Mailing Address |
Proposed
Schedule: (circle) Months of
Operation J F M A M J J A S O N D
Days of Operation S M T W T F S Hours |
Age range
of children to be served |
Services
to be provided ___Infants
& Toddlers 0-2
___ Transportation
___ Other, please specify ___Preschoolers
(3-4) ___
Evening Care ___School
Age (5+) ___
Mildly Ill Care ___School
Age Only ___
Night care |
Type of
entity ___ sole
proprietorship ___ board
sponsored ___ profit ___ non-profit ___
partnership ___
corporation ___ association |
Services
to be provided by consultant ___
Drafting corporate documents for
attorney’s review $500 pre-paid upon invoice (name reservation, articles and
bylaws) ___
Drafting 501.c.3 federal tax exemption
application $650 pre-paid upon invoice ___ Complete BFS licensing application
package Part A (floor & site plan), Operation Plan & Part B $500 Retainer of $250, balance of $250 due
upon receipt of completed application package ___ Provide
contact information and assistance in meeting local
and state ordinances
regarding fire, zoning, building, and health regulations $100 (fee must be pre-paid upon
invoice) ___ Attend
Inspection-Participate in on-site evaluation for compliance with
Department rules and regulations. $50 (fee must be pre-paid upon
invoice) *one week notice necessary to coordinate schedule ___ Perform Mock Inspection of center/school: 0-50
students, 1-12 employees $200; 50-150 students 13-25 employees $500 (fee must be pre-paid upon invoice ___ Cleaning or classroom setup $18/hour
(payment must be submitted within 7 days of receipt of timesheet/invoice) ___ Staff Orientation and/or Training~ *2
days $35/person; 1 week $75/person 5 staff member minimum (registration fees
must be paid 14 days in advance) ___ Strategic
Planning Quarterly Planning Meeting 4 hours $100 (fee must be pre-paid upon invoice) ___ Grant writing $500 retainer and 2% of
funding ___
Kitchen (Assistance with Application
for Child and Adult Care Food Program Enrollment) or Playground Safety
Issues Inspected and Recommendations $100 per service (fee must be pre-paid upon invoice) ___Complete
sales tax exemption application
$50 (fee must be paid upon invoice) |
Please provide the following: (within ___ days)
(within ___ days)
(within ___
days)
|
1. The client agrees to submit requested
information in a time sensitive manner.
2. The consultant agrees to meet weekly with the
client for one hour to monitor the licensing progress and gather necessary
information to complete the application packet or review facility setup per
agreement.
3. The client understands that legal counsel; financial
accounting, auditing, monitoring, and other evaluation procedures are their
responsibility to setup.
4. The client agrees that the program will
strive to meet federal, state and local requirements, and will comply with all
applicable laws.
5. The applicant understands that all fees are
due and payable as outlined in the agreement in order to maintain service and
prevent legal action.
6. The client understands and agrees that
services may be terminated in writing, at any time if the client fails to
provide necessary information to complete tasks or comply with federal, state
and local laws or requirements.
7. The consultant agrees to refund fees for any
service not performed in the event the agreement is terminated by the client,
in writing.
_______________________________ ________________________________
Center Owner Consultant
_______________________
Date
Train up a child in the way he
should go and when he is old he will not depart from it. Proverbs 22:6
Mailing address: