Child Care Reimbursement Payable To: *
Child Care Reimbursement Payable To:
Address *
Address
Group Leader Name *
Group Leader Name
Date of Meeting *
Date of Meeting
Section
Reimbursement Chart # of Children / Amount -- 1 / $21.00 2 / $24.00 3+ / $27.00 **Form must be submitted within 60 days of the event.