Before/After Care Withdrawal Form 2022-2023
Parent(s) or Guardian(s) will remain responsible for all fees incurred up until receipt of written notice of withdrawal is completed.
Student Name
First Name
Last Name
Grade Level
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Parent/Guardian Name
First Name
Last Name
Withdraw my child/children from the following program:
Please Select
Before & After Care
Before Care Only
After Care Only
Parent/Guardian Signature
Clear
Submit
Should be Empty: