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: AIK/Girls Incorporated® of the Island City requires at least thirty (30) days written notice, in advance, of your intention to withdraw from any Alameda Island Kids program. With or without this notice, you will be expected to pay full fees for your child’s final payment period regardless of the number of days of attendance. AIK/Girls Inc. reserves the right to waive the 30-day notice policy due to unforeseen hardship.
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
Please note: There will be a Change Fee (per child/per change—see Fees and Information Schedule) for ANY CHANGES to the program care pattern. There is no charge for canceling care. There is no Change Fee charged for adding additional care when space becomes available and a child is taken off the waitlist.
Current 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