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: ( ) _______________________________________