Child Care Reimbursement

Use this form to be reimbursed for childcare expenses related to small group meetings. Submit this form within two(2) weeks following your meeting. We will only reimburse at the predetermined rate below.

Pay Rates

The following pay rates will be reimbursed up to 4 hours/event.

 1 Child $7.00/hr (max 4 hours)

 2 Children $7.50/hr (max 4 hours)

 3 Children $8.00/hr (max 4 hours)

 4 Children $8.50/hr (max 4 hours)

 5 Children $9.00/hr (max 4 hours)

Name *
Name
Address
Address
Phone
Phone
Date of Event
Date of Event
$