AWAKEN GROUPS CHILDCARE REIMBURSEMENT Instructions: 1. To be filled out by a Group Leader for reimbursement of childcare services. 2. Awaken Church does not pay the childcare provider, we pay the group leader directly to reimburse for their childcare costs. 3. Group leaders are expected to pay their providers after each group meeting. 4. Reimbursement for children 11 years old and younger. 5. Reimbursement to the Group Leader will occur every other week. 6. Check to be mailed within 1 - 2 weeks. Reimbursement must be submitted within 30 days of meeting. If past 30 days of meeting, the group leader assumes the cost of standard rate as indicated below and is responsible for paying the provider. One reimbursement form must be filled out per group meeting: Group Leader Name Date Of Meeting Week 1 2/20-2/26 Week 2 2/27-3/5 Week 3 3/6-3/12 Week 4 3/13-3/19 Week 5 3/20-3/26 Week 6 3/27-4/2 Week 7 4/3-4/9 Week 8 4/10-4/16 Week 9 4/17-4/23 Week 10 4/24-4/30 Week 11 5/1-5/7 Week 12 5/8-5/14 Week 13 5/15-5/21 Other What Date Name of child care provider Number of children 1-2 3-4 5 or more Number of hours 1 2 3 Maximum reimbursement of 3 hours per meeting. If the meeting runs longer than 3 hours, the group leader must pay the child care provider for the additional time according to the rate below. Groups of 5 or more children will be paid at a $10 per hour flat rate. 1 hour 2 hours 3 hours 1-2 Children $8.50 $16 $25.50 3-4 Children $9 $18 $27 5 or more Children $10 $20 $30 **Maximum payout is $30 Make check payable to (group leader) Dollar Amount Requested 1 Hour | 1-2 Children | $8.50 1 Hour | 3-4 Children | $9.00 1 Hour | 5 or More Children | $10.00 2 Hours | 1-2 Children | $16.00 2 Hours | 3-4 Children | $18.00 2 Hours | 5 or More Children | $20.00 3 Hours | 1-2 Children | $25.50 3 Hours | 3-4 Children | $27.00 3 Hours | 5 or More Children | $30.00 Address to mail check if not previously provided Submit Thank you for submitting the childcare reimbursement form. Please turn on javascript to submit your data. Thank you!