Cancellation of Care (Permanent Bookings)

Cancellation of Care - Permanent Bookings
Please use this form if you wish to cancel all your child's bookings

Please note that one form per child is required
Parent/Guardian Name:*

First NameLast Name
Contact Number*
Mobile
Email*
example@example.com
Child's Name:*

First NameLast Name
This request relates to the following service:*
I wish to cancel ALL of my bookings for my child as listed as above*
If you are not cancelling all your bookings, please complete the

Change to Permanent Bookings Form
Reason for cancelling care:
Date of notice (date form submitted)*

DayMonthYear
Last day of care (minimum two weeks notice)*

DayMonthYear
By signing this form, I acknowledge I must give two weeks' notice. this means the last booked session can be no earlier than 2 weeks from the date of notice*

I acknowledge
By signing this form, I acknowledge the Government will only pay CCS up to the last physically attended session. This means, if you finish on an absence or absences, you will not be paid CCS for those sessions.*

I acknowledge
If you would like further information on ending on and absence, please click here
Parent/Guardian Signature*

Clear
Date*

DayMonthYear
If you would like to provide more detail, please complete the

Adventure Patch Family Exit Survey
Should be Empty:

Cancellation of Care - Permanent Bookings