Generic Child Care Sign-In/sign-Out Sheet Template
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1This form must be attached to a GREEN billing sheet.
Do not submit this form by itself. There must be a separate sheet for each child.
GENERIC CHILD CARE SIGN-IN / SIGN-OUT SHEET
STAFF USE
CHILDREN IN SCHOOL
ONLY
Drop Off
Arrive
Pick Up
Parent or Representative
Leave for
Provider
Provider
Parent or Representative
F/T
P/T
Time
from
Time
Full, Legal Signature
School
Initials
Initials
Full, Legal Signature
Hours
Hours
AM/PM
School
AM/PM
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Providers will NOT be paid by PCOE if it appears completion did not take place at ACTUAL time of service. (For
example if the parent completes the billing sheet at the beginning or end of the month.) Children MUST be
signed in and out of care at the ACTUAL time of drop off and pick up.
Provider's Name (Printed)__________________________________
Child's Name (Printed)_____________________________________ Month__________________
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