AIK Change/Cancel Form

ALAMEDA ISLAND KIDS

CANCEL / CHANGE FORM
Date of Request *

MonthDayYear
Date
School Site*
School Site
Current Grade*
Current Grade
Current Care Level*
Current Care Level
Child's Name*
Child's Name
Parent's Name*
Parent/Guardian Name
Parent's Address*
ex: 123 Main Street, Alameda, CA 94501
Cancel/Change as of:*

MonthDayYear
Date
Would you like to cancel your Child's enrollment?*

YesNo, I would like to make a change to my child's current care
Please note: 30-day written notice is required per the Practices and Procedure Manual.
Please tell us the reason for your cancelation *
What would your like to Change/update?*

Billing AddressContact NumberEmail AddressCare Level
New Address*

Street Address

Street Address Line 2

CityState

Zip Code
Old Address*

Street Address

Street Address Line 2

CityState

Zip Code
Old Phone Number*
Please enter a valid phone number.
New Phone Number*
Please enter a valid phone number.
Old Email*
example@example.com
New Email*

Confirmation Emailexample@example.com
Old Care Level*
Old Care Level
New Care Level*
New Care Level
Scroll & Select your site director's Email*
Site Director's Email
Parent/Guardian Signature*

Clear
Should be Empty:

ALAMEDA ISLAND KIDS