Daycare Assistance Reimbursement Contract for Camp Ashreinu

Daycare Assistance Reimbursement Contract for Camp Ashreinu

To be completed by families who will be applying and/or currently receiving government daycare assistance. This must be submitted with registration to Camp Ashreinu along with deposits to be eligible for government funding.
Person filling out form:*

First NameLast Name
Please choose the option that is relevant to you:*

My child/ren is/are currently eligible for Day Care Govt. assistance from the county and we will be using the TAP system to obtain reimbursement.We will be applying in the Spring for eligibility from the government and anticipate that our children will be eligible for state reimbursement.
Please read carefully and sign the following agreement.

This form must be submitted with your children's registration form and non-refundable & non-post-dated deposits in order to be eligible for the government funding.
The following children is/are eligible/will hopefully be eligible for Govt. reimbursement for Camp Ashreinu this summer:*
I understand a $200 payment for an activity deposit fee must accompany each camper's registration. The activity deposit fee is non-refundable, non-transferable, and may not be a post-dated check. I understand my child will not be considered registered until this payment is received.
I understand all of my Camp fees will be deposited upon receipt, unless I post-date them accordingly or specifically request that they wait to be deposited until the final calculations are determined (usually about 4-6 weeks after the last day of Camp).
I understand that I will be responsible for paying all co-pays, camp activities fees (see fee breakdown schedule ), and late fees. At that time, Camp will deposit all of my post-dated checks and reimburse me accordingly.
I understand it is my responsibility to daily log in (upon arrival and dismissal) and to ensure the Camp is being appropriately reimbursed for my children. If I neglect to do so, I will be responsible to pay the Camp what the govt did not reimburse them. Once Camp is over, there will not be staff to assist with the TAP system and the building/machine may not be accessible.
I understand the Camp will not be submitting any manual claims to the county, so it is my responsibility to ensure I am accepted on time, attendance records are completed daily, and ensure that the government appropriately reimburses the camp.
Parent's Name

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