CHILD CARE CANCELLATION/CHANGE REQUEST 2025

CHILD CARE CANCELLATION/CHANGE REQUEST
PLEASE CHECK ONE:*

KID ZONE BEFORE AND AFTER SCHOOL CARE PROGRAMSUMMER DAY CAMPDAYS OUT OF SCHOOL
For Days Out of School, please click the link to be redirected to a different form:

https://form.jotform.com/GJAY1785/doos-cancellation-req
10-day written notice is required for cancellation or change requests for the Kid Zone Before and After School Program.
School District:*
Cancellation Policy

To avoid penalties, cancellations must be submitted by the deadlines listed below:
- For camp weeks in June (June 2, 9, 16, 23, 30): Cancel by May 1, 2025
- For camp weeks in July (July 7, 14, 21, 28): Cancel by June 1, 2025
- For camp weeks in August (August 4, 11): Cancel by July 1, 2025
Fees & Deadlines
- Cancellations made after the deadline listed above will incur a $50 cancellation fee per week, per family. This fee will be charged to the payment method on file.
- If cancellation is not submitted by the Monday prior to the start of the registered camp week, the full payment for that week will be charged.
- Registration fees are non-refundable and non-transferable.
Camp Program:*
How many children is this request regarding?*

1234
Name of Child 1*
School Attending*
Name of Child 2*
School Attending*
Name of Child 3*
School Attending*
Name of Child 4*
School Attending*
Avery Summer Camp Location Site

C.W. Avery Family YMCAWallin Oaks Elementary
Valley View Summer Camp Location Site

Beverly Skoff ElementaryIndependence Elementary
Current Kid Zone Plan*

1-2 days3-5 daysBeforeAfterBefore & After
I wish to:*

Cancel my registrationChange my registration
Program Cancellation
Reason for Cancellation*
Day(s) to Cancel: (select all that apply)

Pre-Camp - Tue 5/27 - MorrisPre-Camp - Wed 5/28 - MorrisPre-Camp - Thu 5/29 - MorrisPre-Camp - Fri 5/30 - Avery, MorrisPre-Camp - Thu 6/5 - Galowich, Salvation ArmyPre-Camp - Fri 6/6 - Galowich, Salvation ArmyPost-Camp - Mon 8/11 - Avery, MorrisPost-Camp - Tue 8/12 - Avery, MorrisPost-Camp - Wed 8/13 - AveryPost-Camp - Mon 8/18 - GalowichPost-Camp - Tue 8/19 - Galowich
Week(s) to Cancel: (select all that apply)

Week 1 - 6/2-6/6Week 2 - 6/9-6/13Week 3 - 6/16-6/20Week 4 - 6/23-6/27Week 5 - 6/30-7/3Week 6 - 7/7-7/11Week 7 - 7/14-7/18Week 8 - 7/21-7/25Week 9 - 7/28-8/1 (Avery, Wallin Oaks, Morris)Week 10 - 8/4-8/8 (Avery, Morris)
Week(s) to Cancel: (select all that apply)

Week 1 - 6/9-6/13Week 2 - 6/16-6/20Week 3 - 6/23-6/27Week 4 - 6/30-7/3Week 5 - 7/7-7/11Week 6 - 7/14-7/18Week 7 - 7/21-7/25Week 8 - 7/28-8/1Week 9 - 8/4-8/8Week 10 - 8/11-8/15
Last Day of Attendance*

MonthDayYear
Date
Change Request
Change Effective Date*

MonthDayYear
Date
Reason for Change*
New Kid Zone Plan*

1-2 days3-5 daysBeforeAfterBefore & After
Current Membership Type*
Regarding my Membership, I would like to:*

Keep ActiveCancelPut on Hold
How long would you like to be on hold? (You are able to reactivate earlier if you so choose.)*
Per the membership cancel/hold policy: I understand my membership dues may draft if this request is less than 10 days prior to my draft and/or I understand that my membership dues will draft after my hold period expires.
We would love to hear about the experience you and your child(ren) had in our child care program.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Signature*

Clear
Today's Date*

MonthDayYear
Should be Empty:

CHILD CARE CANCELLATION/CHANGE REQUEST

Program Cancellation

Change Request