Childcare claim form - providerConnect 2026

1. Click ‘Get Form’ to open the childcare claim form - providerConnect in the editor.
2. Begin by filling out the Childcare Provider Information section. Enter the Childcare Provider Number, select whether it is Not for Profit or For Profit, and provide the facility name, address, and telephone number.
3. Next, complete the Plan Member Information section. Fill in your name, your child's name and date of birth, postal code, employer details, and Green Shield ID number. Indicate if you have any other childcare coverage.
4. In the Claim Information section, specify the claim submission dates and detail the facility rates. Include the number of half days and full days being claimed along with their respective costs.
5. Finally, ensure all required signatures are provided at the bottom of the form. This includes signatures from both the employee/parent or guardian and an authorized facility representative.

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