Childcare Reimbursement - Crossroads Church

Your Information

Group Leader Name

Date of Meeting

Number of Children

Number of Hours

Records of Funds that you paid

Person that you paid

Address

Number of Hours and Number of Children

-----1-----------2-----------2 ½----------3-----------4+
1--$5.00------$10.00------$12.50------$15.00------$20.00
2--$8.00------$16.00------$20.00------$24.00------$32.00
3--$10.00-----$20.00------$25.00------$30.00------$40.00
4+$12.00-----$24.00------$30.00------$36.00------$48.00

Total you paid

Reimbursement Payable to:

Sitter (They are due payment)

Me (I already paid the sitter)