Breakthru® Student Withdrawal Form

Breakthru® Student Withdrawal Form

rel 2025
Withdrawal from Breakthru® Program

As part of the formalities for the offboarding process, we kindly request that you fill out the withdrawal form.
Name of Child*
As per I.C. / Passport
Child's MyKid / MyKad*
My Child's Program is:*

Afternoon CAREBASE programACE programEPIC programVSP programPEARLS programSEL programOther
Withdrawal with effect from:

DayMonthYear
* Please take note that fees are paid by monthly, even if the withdrawal date is earlier.
Withdrawal Details
Reason of Withdrawal*

Back to main stream schoolDistance from homeFinancialMoving on to next developmental centre
Withdrawal Note
Your Important Feedbacks

We would like to hear from you...
We truly appreciate your feedback (e.g., appreciation/acknowledge specific facilitator, areas of improvements, testimonials)
Additionally, we would like to offer you a 20-30 minute meeting (in person or on zoom) with our Breakthru consultant. This meeting will allow us to share our observations on your child's progress and developmental needs, including insights from the integration of primitive reflexes and psychosocial development, which could be beneficial for his continuing progress.
Available for a meet up?

Yes I can. Please contact me.
Father/Mother's Name
MyKad/IC
Signature of Parent as Confirmation*

Clear
Date of submission

DayMonthYear
Date
Should be Empty:

Withdrawal from Breakthru® Program