Payment receipt
Program
Receipt number
Date paid
Program phone
Program address
Received from
Parent or guardian
Phone or email
| Child’s name | Dates of care | What it is for | Amount |
|---|---|---|---|
Total paid
Balance still owed after this payment
Paid by:CashCheckCardBank transferOther
Check or reference number
Received by
Signature
Date
Thank you. Please keep this receipt for your records.
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