Childcare Reimbursement

"*" indicates required fields

Your Name*

First Last

Your Email*

Your Address*

Your payment will be mailed to this address unless other arrangements have been made with WPC's financial secretary.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date Childcare was Provided*

WPC Event Childcare was Provided for*

(Example: Sanctuary Choir, It's Elementary, Youth Groups)

What is the name of the childcare provider?*

Time Sitter Arrived at Childcare Location*

Time Sitter Departed Childcare Location*

Child's Name Childcare was Provided for*

Enter all children's names that childcare was provided for during the time frame listed above.

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