EmailMeForm
Childcare Assistance Form
Guidelines for childcare assistance:
Church will reimburse the family up to 12$ per hour (3.5hr max) for childcare in your home. The family is responsible for finding and scheduling in-home childcare.
Name
*
First
Last
Email
*
Date of Service Provided
*
MM
/
DD
/
YYYY
How many children were cared for?
*
How many hours were covered by childcare?
2 hours
3 hours
3.5 hours
What percentage of the total payment are you requesting?
*
25%
50%
75%
All