Child Care Expenses Receipt for Income Tax Purposes
I received from ____________________________________________________ the sum of $_______________,
                   Name of parent or parents (or other person, if applicable)
for caring for: ___________________________________________________________________________________
                                         First and Last name of Child or Children
These child care fees were paid for the period of ____________________ to _______________, 20______.
                                                               Month/Day            Month/Day
Child Care Services Were Provided By:           ______________________________________________
                                                                Signature & Date
Information about the person or company issuing this receipt (required by the Canada Revenue Agency):
Child Care Provider’s Printed Name:_____________________________________________________________
Address: _______________________________________________________________________________________
Telephone Number: (          ) _______________________________________