Voluntary Agreement: Inactive Due To Emergency Health And Safety Issues
Legally-Exempt Child Care (3/24/14)
I, ______, have been informed that my child care program,
NAME OF CHILD CARE PROVIDER/DIRECTOR
______, located at:
NAME OF CHILD CARE PROGRAM
______
______
is not in compliance with the Official Compilation of the Codes, Rules and Regulations of New York State, Part 415, and, I must stop providing subsidized child care due to the EMERGENCY situation.
I understand the Enrollment Agency named herein has made determination that children in my care are in IMMINENT DANGER or at IMMINENT RISK OF HARM. I understand the health and safety concerns are serious enough to warrant termination of my enrollment. The enrollment agency agrees to allow me to remain enrolled while I correct the health and/or safety issues under the conditions listed below.
I agree to abide by the following conditions while I correct the non-compliance issues and until I am approved to provide subsidized child care.
1. I agree that all subsidized children will be immediately sent home and the enrollment agent may remain on site until this is done,
2. I agree to correct the non-compliance according to the Corrective Action Plan which this agreement is a part of,
3. I agree I will NOT provide care for subsidized children until the non-compliance is corrected AND the corrections have been approved by the Enrollment Agency,
4. I understand and acknowledge that NO subsidy funds will be issued for the time period that I am inactive due to the EMERGENCY situation caused by the health and safety issues, because I will NOT be caring for subsidized children during this time,
5. I understand the Enrollment Agency will inspect my program on (date)______, or earlier, if I notify the agency prior to that date that corrections have been made,
6. I understand all subsidized parents for whom I provide child care and their Local Social Services Districts will be notified today of this action, and
7. I understand that if I do not correct the non-compliance issues identified on the Corrective Action Plan to the satisfaction of the Enrollment Agency by (date)______, my enrollment will be TERMINATED.
PROVIDER SIGNATURE______DATE ______
ENROLLMENT AGENT SIGNATURE______DATE ______
ENROLLMENT AGENCY INFORMATION
Name: ______
Address: ______
Contact Person: ______/ Phone Number: ______
Instructions to Enrollment Agency:
Leave a copy of this agreement with the provider at the time it is signed.
Provide a copy of this agreement to the Local Department of Social Services as needed.