Notice of Withdrawal from Enrolment at Pilgrim School

1

Parent/Caregiver 1 name:* This field is required.

First Name

Last Name

2

Parent/Caregiver 1 email:* This field is required.(A copy of the submitted data will be emailed to this address)

example@example.com

3

Parent/Caregiver 2 name:Complete if applicable - leave blank if not applicable

First Name

Last Name

4

Parent/Caregiver 2 email:Complete if applicable - leave blank if not applicable

example@example.com

5

Name(s) of students at Pilgrim School to which this Notice of Withdrawal applies:

First name

Last name

First name

Last name

First name

Last name

First name

Last name

6

Intended Departure Date (ie the last day of attendance at Pilgrim School)* This field is required.(If the enrolment is concluding at the end of the 2025 school year, the last day of attendance will be 10/12/2025)

Date

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Notice of Intention to Withdraw:

I/We hereby advise my/our intention to withdraw my/our child/ren from Pilgrim School on the Intended Departure Date specified in this form.

In accordance with my/our enrolment contract and Pilgrim School's fee policies I/we understand the requirement to give a clear term's notice of intention to withdraw enrolment otherwise a term's fees are due and payable in lieu of that minimum notice.

(For withdrawal at the conclusion of the school year, notice must be provided to the school by the last day of Term 3 to comply with this obligation.)

8

Enrolment Deposit Refund/Credit (where applicable)In the event that any Enrolment Deposits paid are refundable, these will first be applied against outstanding fee balances. Where fees have been paid in full, you can request a refund of your enrolment deposit(s) by providing your bank account details below.

BSB

Account number

Account name

9

Departure Survey:

We are keen to understand the reasons for your withdrawal and so invite you to provide feedback as you reflect on your time in our school community. We appreciate you taking the time to complete this survey.

10

What were your main reasons for initially enrolling your child/ren at Pilgrim School?* This field is required.

11

As a family, what have you valued most about your time at Pilgrim School?* This field is required.

12

I/We would like Pilgrim School to do more of...* This field is required.

13

I/We would like Pilgrim School to do less of...* This field is required.

14

I/We would like Pilgrim School to do the following things differently...* This field is required.

15

What are your main reasons for withdrawing your child/ren from Pilgrim School?* This field is required.

16

Please share any other additional information about your experience that may be helpful as we continue to plan into the future

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What school will your child/ren be moving to?* This field is required.

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Parent/Caregiver 1 signature:* This field is required.Sign here using your mouse (or finger for touch screens). Where this is the only signature provided, you are declaring that you have the sole authority to withdraw the student's enrolment at Pilgrim School.

Clear

19

Parent/caregiver 2 signature:Sign here using your mouse (or finger for touch screens)

Clear