Thank you for providing childcare during Connect Group meeting times!

Please complete the application for childcare reimbursement below. Be sure to include all required information, and refer to the CHILDCARE REIMBURSEMENT POLICY to identify the appropriate amount. Remember: Each form must be submitted within seven days following the group meeting in order to qualify for reimbursement.

  • Name
  • Phone Number
  • Group Leader
  • Date of Meeting
  • Amount of Reimbursement