TLC Groupcare Membership Registration Form

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Thank you for your interest in Utilizing TLC to help Staff your Group care needs.
Items marked with an * are required.
What is the legal name of your organization? :*
What is the main phone number of your organization? :* Extension:
Please provide a primary contact name. *
Please provide the phone number for the primary contact.* (eg. 5553331212)
Please provide an email address where we can reach the primary contact.*
Password:* Confirm Password:
Please Identify a secondary contact (contact # 2) in your organization that may also be involved with scheduling, billing, etc.
Phone number for Contact # 2. (eg. 5553331212)
Please provide the address where care will take place.*
City:* State:* Zip:*
Please provide your billing address if different from care location.
City: State: Zip:
How often will you need Caregivers to support your group?*
Please provide your best estimate of the number of children who will be present and their age ranges. *Please note it is important to distinguish between the number of children under 3 years old and the number of children 3 years or older in order for TLC to set proper staffing ratios.
Pay Option One: Client pays each caregiver directly the day of the job(s) $17 per hour (four hour minimum per caregiver) • Client pays TLC $7.00 per hour for each caregiver, charged to a credit card.

Pay Option Two: Client pays TLC an hourly rate of $30 per hour that includes TLC’s fees and Caregiver’s wage. Caregiver is paid on TLC’s payroll. 50% deposit and credit card are required.

(four hour minimum is required regardless of payment option selected).
Payment Method*
Please provide anything you need us to know about your event, the kids, the organization and what you are needing form TLC and our caregivers.

Please provide a valid credit card Number and expiration date (Visa, Mastercard, American Express, and Discover only) . Your card will not be charged until we have contacted you and agreed on arrangements.

Card Type:  Master Card,  VISA  Discover or  AMEX
Credit Card # (no spaces or dashes) * Exp. date :
Name on Card: *

Terms of this agreement:

1. Client Understanding and Release.
TLC agrees to provide care for children of attendees of Client’s event or center. Client understands that TLC may not be able to provide care for children not on the approved list. Client may wish to require parents to register ahead of time in order to gauge numbers and ages of children. TLC recommends that Client overestimate this number in order to accommodate last-minute requests or drop-ins. Otherwise, TLC may have to turn away children in order to maintain ratios (see #3 below).
2. Fee Schedule.*
Client agrees to pay TLC’s fees as follows:

Option One:**
• Client pays each Caregiver directly the day of the job(s)$17 per hour.
• Client pays TLC $7.00 per hour for each Caregiver, charged to a credit card. (The four hour minimum applies to both the Caregiver's and TLC's fees)
• If Option one is selected, Client understands that the Caregivers providing service at Client’s event or facility are not employees of TLC.

Option Two:**
• TLC pays the Caregivers via our payroll.
• Client is billed Total of $30.00 per hour per caregiver*.
• $30.00 per hour per Caregiver; all-inclusive (Agency fees and Caregiver Pay) four-hour minimum per day per Caregiver; paid directly to TLC, billed to a Mastercard, Visa, Discover, or American Express.
*For event care staffing a 50% deposit will be required.
**Additional fees will apply when an on-site coordinator and/or supplies are requested.
Client is also responsible for any parking charges incurred by caregivers.
Four-hour minimum will be charged for all jobs that are cancelled after TLC has confirmed the caregiver.
3. Child to Caregiver Ratios. TLC and Client agree to the following ratios:
Event Care: Five children (maximum) age 3 and up to one caregiver; three children (maximum) under age 3 to one caregiver.
Daycare Subs: State ratios apply
4. Qualifications of Caregivers
TLC agrees to provide caregivers who have been carefully screened, including personal interviews, criminal record checks, verification of child care references /experience and child abuse/neglect screenings.
5. Services Provided by Caregivers.
TLC agrees that caregivers will provide child care for attending children, including playing games, reading books, and organizing arts and crafts activities; serving meals, snacks and bottles; and changing diapers and organizing trips to the restroom. Client understands that caregivers cannot administer medication to children.
6. TLC’s Insurance Policies.
TLC also acknowledges that it maintains general liability insurance, errors and omissions insurance, and a surety bond. Certificates of Insurance can be provided upon request. TLC recommends that Client acquire an umbrella policy from Client’s insurance company for additional coverage.
7. Indemnification.
Client agrees to forever indemnify, release and hold harmless TLC, its agents, employees and officers for any and all claims of any nature, including, but not limited to, injury of children in the care of caregivers provided by TLC.
8. Liquidated Damages.
Client understands that the services provided by TLC must be contracted through the TLC office. Client agrees not to hire directly or refer to a third party any caregiver whom Client meets through TLC. Client further agrees that use of a TLC caregiver without arranging the visit through TLC will result in a charge of $1,800 for liquidated damages.
9. Conditions of the Agreement.
This instrument contains the entire agreement between the parties and may not be changed orally; all changes must be made in writing and approved by Client and TLC. This agreement shall be interpreted and construed under and in accordance with the laws of the State of Missouri.

I have read and understand the terms of the agreement. *