CHILD DROP FORM
NC Pre-K Site Name:
*
Classroom Name
*
Classroom Teacher's Name
*
Child's Name
*
Child's First Name
Child's Last Name
Date Child Dropped
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason Child Dropped (select one)
*
Child moved out of county/state
Child moved to a different Child Care Facility/NC Pre-K Classroom
Parent no longer can provide transportation
Other or parent is dissatisfied with the program. Explanation required:
Optional Additional Information:
Teacher/Administrator Signature
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
(Name of new child)
Date slot filled
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: