Instruction
Please use the form below to submit a request for payment to your childcare provider during the retreat. All payments will go directly to the caregiverโ€”we do not pay families. You may submit your reimbursement request as soon as you know the name of your provider. Keep in mind there is a $150 maximum reimbursement limit per family.

All requests must be submitted by Monday, January 30.
Your Name *
Your Name
To whom the check should be made out
Caregiver Address *
Caregiver Address
Where the check should be sent
Amount to be paid, up to $150.
$