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Employee Email*

Please include your work email when submitting your reimbursement request

Personal Email

Employee First Name*

Employee Last Name*

Dependent/Child 1 First Name*

Dependent/Child 1 Last Name*

Dependent/Child 1 Birthdate*

Year/Month/Day

Dependent/Child 2 First Name

Dependent/Child 2 Last Name

Dependent/Child 2 Birthdate

Year/Month/Day

Dependent/Child 3 First Name

Dependent/Child 3 Last Name

Dependent/Child 3 Birthdate

Month/Day/Year

What did you use Care Cash for?*

Child Care

Elder Care

Please share more details below:*

My child's daycare is closed

My child did not have school that day

My caregiver called out sick

My caregiver is on vacation

My relative has temporary caregiving needs

Other

When and where did you use care?

Care Start Date*

Year/Month/Day

Care End Date*

Year/Month/Day

Care Start Time*

e.g. 9 AM

Care End Time*

e.g. 5 PM

Care Cash Location

Bright Horizons - Marlborough, MA

In Home - Family Member

In Home - Private Caregiver

New Horizons Academy - Arden Hills, MN

Onsite Licensed Childcare

Other

Care Provider*

Please provide the name and phone number of your care provider if other than Bright Horizons or New Horizons Academy

Reimbursement Amount*

You are eligible to submit up to $175 USD per day, less a $10 co-pay per child, when using onsite campus care at Bright Horizons or New Horizons Academy, and up to $100 per day when sourcing your own caregiver. A reimbursement for a personal caregiver will only be approved if Vivvi, Bambino, New Horizons or Bright Horizons was unable to secure care for you.

Upload your proof of payment here:*

Acceptable forms of proof of payment include a screenshot of your Venmo/Paypal transaction, a photo of a check, or a receipt or invoice. Please email us at carecash@vivvi.com with any questions. If using a personal caregiver, you must also show proof that care could not be fulfilled through Vivvi, Bambino, New Horizons or Bright Horizons.

I confirm the information I am submitting is accurate, current and complete.

By completing this form, you confirm you agree to Vivvi's Terms & Conditions, which can be found here.

I agree to Vivvi's Terms & Conditions