Title Page
-
Conducted on
-
Prepared by
-
Family Name
-
Job Address
-
Cell Number
-
Hotel/Home Number
-
Childcare Provider Name
Time Sheet
-
Date of Service
-
Day of Week
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
Start Time
-
End Time
-
Total number of Hours
Childcare Provider Charges
-
Number of Children
-
Rate per Hour
-
Hourly Rate$___ X Total Hours=
-
Mileage $.25 X ___ Miles =
-
Provider Total = Hourly + Mileage (To be Paid in Cash)
-
Agency Referral Charge = Daily/Weekly/Monthly/Hotel: $8/hr X Total hrs Annual Members: $4/hr X Total hrs
-
Sitter
-
Client
