Reporting Period:
Children:
Child's Full Name | Date of Birth | ||
|---|---|---|---|
A | B | ||
1 | |||
2 | |||
3 | |||
4 | |||
5 | |||
6 | |||
7 | |||
8 | |||
9 | |||
10 |
Care Provider Full Name:
Care Provider Contact Information:
Phone Number:
Email:
Address:
Care Provider License Number:
Tax Identification Number/EIN of Provider:
Days of the Week Care Provided:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hours of Care:
Start Time:
End Time:
Number of Weeks:
Number of Months:
Were there any absences?
Number of Days:
Reason:
Were there any variations in the regular schedule?
Why? Please provide details.
Tuition/Fees:
Payment Date | Frequency (Weekly, Monthly, etc.) | Notes | Amount | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | |||||
2 | |||||
3 | |||||
4 | |||||
5 | |||||
6 | |||||
7 | |||||
8 | |||||
9 | |||||
10 | |||||
11 | Total: | $0.00 |
Registration Fees:
Payment Date | Description | Amount | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 | ||||
11 | Total: | $0.00 |
Supply Fees:
Payment Date | Description | Amount | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 | ||||
11 | Total: | $0.00 |
Late Fees:
Date of Late Pickup | Date Paid | Reason | Amount | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | |||||
2 | |||||
3 | |||||
4 | |||||
5 | |||||
6 | |||||
7 | |||||
8 | |||||
9 | |||||
10 | |||||
11 | Total: | $0.00 |
Other Fees:
Payment Date | Description | Amount | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 | ||||
11 | Total: | $0.00 |
Grand Total Expenses:
Payment Method:
Other Payment Information:
Payment Date | Amount Paid | Receipt Attached? Tick if Yes | Receipt Attachment | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | |||||
2 | |||||
3 | |||||
4 | |||||
5 | |||||
6 | |||||
7 | |||||
8 | |||||
9 | |||||
10 |
Is the care provider a qualified individual or organization?
Did you receive a Form W-10?
Reason for Care:
Percentage of Time Spent in Care:
Subsidies and Financial Assistance:
Source | Description | Amount | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 | ||||
9 | ||||
10 |
Form Template Instructions
Please remove Form Template Instructions before publishing this form
This Childcare Expense Report form is designed to capture comprehensive information about childcare costs, attendance, and related details. It's structured to be useful for various purposes, including:
Here's a breakdown of each section and its importance:
I. General Information: This section establishes the context for the report.
II. Attendance and Schedule: This section details the childcare arrangement.
III. Expenses: This is the core of the report, detailing all childcare-related costs.
IV. Tax-Related Information: This section gathers information needed for tax purposes.
V. Optional Information: This section collects additional details that may be relevant for specific purposes.
Overall Insights:
This form is well-structured and comprehensive. By collecting this information, you can effectively manage your childcare expenses, prepare for taxes, and potentially access financial assistance. The level of detail required in each section highlights the importance of keeping thorough records throughout the year.
To configure an element, select it on the form.