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Foster Parent Daycare Sheet Daycare reimbursement is for the following reasons only: work, court, conference, meeting, and training. Director’s approval is required for other daycare. If you are not sure if certain daycare is reimbursable, please check with the child’s caseworker. One child per sheet. One daycare provider per sheet. Child’s Name Month of Daycare Date Reason for Daycare Time In Time Out Time In Time Out Hours 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Foster Parent Signature & Date Caseworker Signature & Date Daycare Provider Signature & Date Supervisor Signature & Date Director Signature & Date OFFICE USE ONLY DAYCARE PROVIDER □ LICENSED, CERTIFIED OR REGISTERED □ NOT LICENSED, CERTIFIED OR REGISTERED IVE Eligible 83 Daycare if provider is licensed, certified or registered & daycare is for the reasons listed above Other daycare with Director’s approval is NOT IVE eligible Case No CIN Auth #