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 caregiver—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, February 1.
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.