OARDC CHILD CARE PROGRAM APPROVAL FORM

							                                     OARDC CHILD CARE PROGRAM

        APPROVAL FORM FOR WORKING A UNIVERSITY OBSERVED HOLIDAY (CREATED 1/2010)



Employee/Student Name:

Child Care Provider’s Name:

Reimbursement Requested for Month/Year:

Reimbursement for (Holiday/Date):

Child’s Name (one form per child):



I certify that I worked the above listed OSU/OARDC observed holiday and my child was in his/her regular
approved child care provider. I also certify that my spouse (if applicable) also worked the above listed
holiday.




Signature of Employee/Participant




Approved:

Signature of Supervisor



Signature of Child Care Provider




Please attach completed form to monthly submission of Child Care forms and receipts.