Submit Name of Recipient:
bid to:
Address:
Case no.
In/Home Relative I child - $.50 per hour 4 children - $1.10 per hour
Child Care Rates 2 children - $.70 per hr. 5 children - $1.30 per hour
3 children - $.90 per hr. 6 children - $1.50 per hour
(Maximum of eight hours per day allowed) | ($2.00 minimum per day) | |||||
Date | Child(rens) Name(s) | No.of child. | Rate | Hours provid. | Daily amount | Gross amount |
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15. | x | = | ||||
16. | x | = |
Signature of Caretaker: Date:
Address:
SWWN-002 R1074
NONE OF THE FORMS FROM THIS POINT TO THE END COULD BE CONVERTED TO MACHINE READABLE FORM FOR THIS VERSION OF CHAPTER 311. PLEASE CONTACT THE DEPARTMENT FOR PAPER COPIES OF THESE FORMS.
C.M.R. 10, 144, ch. 311, BILL FOR CHILD CARE SERVICES