Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LIFE GROUP CHILDCARE The Bridge understands the importance of childcare and how much of a value it can be within our Life Group model. Although it is the Life Group participants responsibility to coordinate their childcare needs, we are committed to assisting in the financial responsibility. The Bridge will reimburse up to $10.00 per hour, per babysitter for Life Group childcare. Please use this form to submit a childcare reimbursement request. Today's Date *Email *Campus *PortageVicksburgCheck Payable To FIRST & LAST *Life Group Name **Leader Last Name*Check Delivery *Pick Up at the Church Office – PortageMailDo we have your address? *YESNOAddress *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEvent Date *Number of Hours *Amount *Do you have more? YESEvent Date Number of Hours AmountDo you have more? YESEvent Date Number of Hours Amount Do you have more? YESEvent DateNumber of Hours Amount have Due Campus NotesTotal Due$0.00Submit
