Dha Child Care 2145s Saccounty Net 2015

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Sides must be complete, and the front must be signed and dated by both the provider and the parent on or after the last day of care. All forms must be received no later than 3 months after care took place for payment to be made. If this form is received late or incomplete, payment will be denied. • Check that all hours/days/weeks entered in Section 4 - Billing Summary below matches the hours/days/weeks of care used on the back. • Each day the child does not use care as scheduled and payment is...

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