24-25 Before/After Care Withdrawal Form

Before Care and/or After Care Withdrawal Form 2024-2025

Parent(s) or Guardian(s) will remain responsible for all fees incurred up until receipt of written notice of withdrawal is completed.
1st Child*

First NameLast Name
1st Child Grade Level *
2nd Child (if applicable)

First NameLast Name
2nd Child Grade Level (if applicable)
3rd Child (if applicable)

First NameLast Name
3rd Child Grade Level (if applicable)
4th Child (if applicable)

First NameLast Name
4th Child Grade Level (if applicable)
Parent/Guardian Name*

First NameLast Name
Withdraw my child/children from the following program:*
Parent/Guardian Signature*

Clear
Should be Empty:

Before Care and/or After Care Withdrawal Form 2024-2025