Childcare Reimbursement

Small Group Childcare Reimbursement

1. This form is for Deer Creek Church members & attendees who are currently experiencing a financial hardship and need assistance with childcare while attending one Small Group per semester.

2. Fill out one form per month with the dates you attended each Small Group meeting during that month.

3. Refer to the chart provided for the set hourly rate so you can budget for childcare accordingly.

Checks will be mailed 1 to 2 weeks after receipt of the form.

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

First Name *

Last Name *

Address 1 *

Address 2

City *

Country *

Zip / Post Code *

Phone *

Email *

Name of Small Group *

Small Group Leader *

Total $ Amount (should match the total of all the dates below) *

Meeting Reimbursement #1: Date, # of Children, # of Hours, Reimbursement Amount Requested, Name of Childcare Provider *

Meeting Reimbursement #2: Date, # of Children, # of Hours, Reimbursement Amount Requested, Name of Childcare Provider

Meeting Reimbursement #3: Date, # of Children, # of Hours, Reimbursement Amount Requested, Name of Childcare Provider

Meeting Reimbursement #4: Date, # of Children, # of Hours, Reimbursement Amount Requested, Name of Childcare Provider

Meeting Reimbursement #5: Date, # of Children, # of Hours, Reimbursement Amount Requested, Name of Childcare Provider