Group Childcare Reimbursement Form

Instructions: 1. This form is to provide childcare financial assistance for approved groups at The Church at LifePark. *Note: this form is ONLY to be used if MORE than ONE family is bringing their children to a LifeGroup and sitters are hired to watch the children at the group meeting. 2. LifePark will reimburse $17.50 per hour for a max of two sitters for two hours per week, per group. 3. Each group is responsible for hiring and coordinating their own sitters as well as completing and submitting this form in a timely manner. Please fill out and submit monthly. *Note: forms submitted three months past the meeting date, will not be accepted.

Your name *

Email address *

Address *

Which LifeGroup do you attend? *

Date (Meeting 1) *

Number Of Hours (Meeting 1) *Not to exceed 2 weekly *

Amount To Reimburse (Meeting 1) *Not to exceed $35 per sitter weekly *

Date (Meeting 2)

Number Of Hours (Meeting 2) *Not to exceed 2 weekly

Amount To Reimburse (Meeting 2) *Not to exceed $35 per sitter weekly

Date (Meeting 3)

Number Of Hours (Meeting 3) *Not to exceed 2 weekly

Amount To Reimburse (Meeting 3) *Not to exceed $35 per sitter weekly

Date (Meeting 4)

Number Of Hours (Meeting 4) *Not to exceed 2 weekly

Amount To Reimburse (Meeting 4) *Not to exceed $35 per sitter weekly

Date (Meeting 5)

Number Of Hours (Meeting 5) *Not to exceed 2 weekly

Amount To Reimburse (Meeting 5) *Not to exceed $35 per sitter weekly

Total amount to reimburse *