Print A Child Care Receipt

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.

Provider/Business Name:
Your name or the name of your child care business

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

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

Amount:
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

For Child Care Services from:
First day of care for this period

To:
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: