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IMPORTANT!

Do not fill in any private information such as a social security number in these forms.

 

What this receipt looks like:

RECEIPT FOR CHILD CARE SERVICES

 

Provider/Business Name:  Daycare Days Child Care           Date Received:  01/01/2007

Received from:   Parent Joe and Cathy Someone                            

Amount:  $145.00       Written Amount:  one hundred forty five and no cents    

Paid By: Check  5555 

For Child Care Services from  01/01/2007   To  01/05/2007

 _______________________________________________ Provider Signature  ________Date

 _______________________________________________  Parent Signature     ________Date

 

 

PRINT A RECEIPT FOR CHILD CARE SERVICES USING THIS FORM

 

Form Instructions:

When filling in the dollar amounts do not use dollar signs ($). They will be filled in when you submit the form. If you are not satisfied with the information on the finished contract you can click your browser back button to change the data.



                                               Your name or the name of your child care business    


                The date you received this payment  
                      Date Format=xx/xx/xxxx
                                           


                                   Parent/Guardian(s) name(s) that gave you this payment 


   The numeric amount of this payment

Written Amount:  
                                  The written amount of this payment in dollars 
                        for example: One hundred forty-five dollars and no cents

 
                                             First day of care for this period

 
     Last day of care for this period

 

Type either cash or check in the first field, if check is selected enter the check number in the second box

  

Notes:

                              

 

     

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Last Update: 08/17/10
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