Childcare Reimbursement Form

Nellis Area Spouses Club Charitable Association

Childcare reimbursement is available for Volunteers of the Airman's Attic and/or Thrift Shop when pre-authorized by Management. Requestors must submit this completed form, along with a receipt from the childcare provider that includes the name of the provider as well as the date and time the childcare was provided.

Up to $6/hour, per family, is eligible for reimbursement. This form and the uploaded receipt(s) will be reviewed by the Chief Charitable Officer who will validate the hours and submit for payment to the volunteer.

Forms must be turned in no later than the end of the month for which the childcare was provided. Any payment issued via check will expire after 45 days; prompt deposit of the payment is appreciated. Requests will not be approved for childcare providers who reside, including visitors, in the same household.

You may submit up to 5 shifts on one submission.

Reference: Nellis Area Spouses' Club Charitable Association Volunteer Handbook, Revised April 2023
Volunteer Name*
Email*
example@example.com
Today's Date*

MonthDayYear
Date
Phone Number*
Address*
Volunteer Date (1)*

MonthDayYear
Date
Volunteer Location (1)*
Volunteer Time (1)*
Total Hours (1)*
Provider Name*
Provider Address*
Provider Phone Number*
Please enter a valid phone number.
Provider Email Address*
example@example.com
Volunteer Date (2)

MonthDayYear
Date
Volunteer Location (2)
Volunteer Time (2)
Total Hours* (2)
Provider Name
Provider Address
Provider Phone Number
Please enter a valid phone number.
Provider Email Address
example@example.com
Volunteer Date (3)

MonthDayYear
Date
Volunteer Location (3)
Volunteer Time (3)
Total Hours (3)
Volunteer Date (4)
Volunteer Location (4)
Volunteer Time (4)
Total Hours (4)
Volunteer Date (5)

MonthDayYear
Date
Volunteer Location (5)
Volunteer Time (5)
Total Hours (5)
Provider Name
Provider Address
Provider Phone Number
Please enter a valid phone number.
Provider Email Address
example@example.com
*Up to 1/4 hour before/after volunteer shift may be included for travel time from/to childcare facility.

Hours will be rounded to nearest 1/4 hour.
Receipt Upload

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