Childcare Reimbursement 
Vintage Church will reimburse up to $20 per Bible study (or approved church event) to any family who would like to arrange their own childcare in the their own home during any of our scheduled Bible study times (or approved church events) through January 19, 2014. After each study (or approved event), simply fill out this form and we will confirm childcare and send you a reimbursement check within 5 business days.

**Childcare reimbursements cannot be paid to members of your family.  

Parent/Gardian Name *
Parent/Gardian Name
Phone
Phone
Home Address
Home Address
Childcare Provider (babysitter information)
Childcare Provider Name *
Childcare Provider Name
Childcare Provider Phone *
Childcare Provider Phone
Bible Study/Event Date *
Bible Study/Event Date
Confirmation *
I confirm that my child was cared for by the childcare provider mentioned above during this approved church event. I understand that the information in this form must be verified by Vintage Church before any reimbursements are made. Please allow at least 5 business days for checks to be mailed after verification has been completed by our staff.