2025-26 AM/PM Schedule Change Form

1
Do NOT use this form to enroll your child for the 2025-26 AM/PM Program

If for any reason you decide to change or drop your child's enrollment from the City of Peoria AM/PM Program, notification must be submitted no later than the 20th of this month for any changes next month. Schedule changes will be NOT be accepted after the 20th of this month for any changes next month. You must use this change form for your request. Verbal changes at the site or with customer service over the phone are NOT accepted. Please complete this form and submit when done.

*There is NO Fee to submit a schedule change request.*

** Schedule Changes requesting additional days are NOT guaranteed. Space is limited at each location and your schedule change request may NOT be approved. You will be contacted if your request CANNOT be accommodated.

Drop In schedules are NOT available.
2
Child Information* This field is required.
Parent First and Last Name
CHILD'S FIRST Name
CHILD'S LAST Name
Please Select
Please Select
Alta Loma
Apache
Cheyenne
Cotton Boll
Country Meadows
Coyote Hills
Desert Harbor
Ira Murphy
Lake Pleasant
Oakwood
Oasis
Parkridge
Paseo Verde
Peoria Elementary
Santa Fe
Sky View
Sundance
Sunset Heights
Sun Valley
Vistancia
Zuni Hills
AM/PM Site
3
Email* This field is required.
Parent/Guardian E-mail Address
4
Phone Number* This field is required.
Parent/Guardian Phone Number
5
Request Type:* This field is required.
Please change my child's weekly attendance schedule.
My child will be ABSENT
Withdraw my child permanently from the AM/PM program.
6
What is your child's new schedule type? * This field is required.
Full Time (AM and PM care, Mon-Fri every week, $95 per child, per week)
Part Time (AM or PM care)
Early Release Days, PM Care ONLY (Wednesdays, Parent Teacher Conferences, Dec 18 and May 21)
7
Please select your child's NEW weekly attendance schedule below. (select ALL days your child will attend each week)* This field is required.
Monday
Tuesday
Wednesday
Thursday
Friday
AM Care ($9 p/day p/child)
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
PM Care ($15 p/day p/child)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
AM Care ($9 p/day p/child)
PM Care ($15 p/day p/child)
Monday
Row 0, Column 0
Tuesday
Row 0, Column 1
Wednesday
Row 0, Column 2
Thursday
Row 0, Column 3
Friday
Row 0, Column 4
Monday
Row 1, Column 0
Tuesday
Row 1, Column 1
Wednesday
Row 1, Column 2
Thursday
Row 1, Column 3
Friday
Row 1, Column 4
1 of 2
8
Effective date of NEW attendance schedule (must be next month or later)* This field is required.
Date
Month
Day
Year
9
Withdrawal - Last Date Child Will Attend: (Submit by Thurs at 12 noon the week prior to the last day of attendance.)* This field is required.
Date
Month
Day
Year
10
Reason for Withdrawal* This field is required.
0/50
Huge
Large
Normal
Small
Ok
Ok
11
First Date child will be absent from AM/PM program* This field is required.
First Date Child Will Be Absent
Month
Day
Year
12
Date child will RETURN to the AM/PM program* This field is required.
Date child will return to the program
Month
Day
Year
13
Additional information/comments
0/50
Huge
Large
Normal
Small
Ok
Ok
14
By submitting this schedule change form, I understand that I am amending my existing 2025-26 AM/PM Registration Contract and I agree to continue abiding by the policies and guidelines as originally signed at time of registration.

Reminder: Schedule changes must be submitted by the 20th of this month for any changes next month. Additional days of attendance are NOT guaranteed. You will be contacted if your request CANNOT be accommodated.
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