Foster Parent Mileage & Babysitting Expense Form (Page 2 of 2) in pdf

Foster Parent Mileage & Babysitting Expense Form Page 2

FOSTER PARENT MILEAGE FORM

By applying for this reimbursement for travel expenses it is understood that prior to this vehicle use I have complied with the

Society's regulations governing the use of private vehicle on Society business

(1) I hold a valid Ontario Driver's Licence.

(2) My vehicle is equipped with a child safety seat Anchor Bolt.

(3) My vehicle is in a safe and roadworthy condition.

(4) The vehicle driven by me on society business is insured for public liability and property damage to a minimum of $1,000,000

I understand that the Society will assume no responsibility other than to pay the mileage rate.

Legend:

M - Meeting, X - Medical/Therapy, R - Recreation, S - School, V - Access visit with family, C - Camp, O - Other

(refer to

From

Date

Name of Child

legend)

Actual

Purpose

Parking

(if applicable)

Street #

Street

City

Street #

Street

City

CIC Travel Babysitting

* Should be accompanied by receipts

* PLEASE TRANSFER TOTALS TO THE FRONT PAGE*

TOTAL

Babysitting: any individual babysitting expenses in excess of $45.00 must be accompanied by receipts

km @ ________________

=$ _____________

Foster Parent Mileage & Babysitting Expense Form Page 2