Child Care Camp Reimbursement Claim

Child Care Camp Reimbursement Claim
Submit your claim for reimbursement of eligible child care camp expenses. Please complete all required fields and attach supporting documents.
Claimant's Full Name
First NameLast Name
Claimant's Email Address
example@example.com
Claimant's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child's Full Name
First NameLast Name
Child's Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Camp Name
Camp Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Camp Attendance Dates
Total Amount Claimed (USD)
Upload Proof of Payment (e.g., receipt, invoice)
Cancelof
Preferred Reimbursement Method
Additional Comments (optional)
Signature
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