30-Day Notice of Withdrawal Form
Please complete this form to notify us of your child's withdrawal from the preschool and childcare program. Ensure all information is accurate and submit at least 30 days before the intended final withdrawal date.
Child's Full Name (one form per child)
*
First Name
Last Name
Select Program Location
*
Orange
Tustin
Select the agency that assists with tuition payments (if applicable):
*
None / Private Pay
CalWORKs
Children’s Home Society (CHS)
Orange County Department of Education (OCDE)
Child Care Specialist/Worker Information:
I understand that my child’s last day of enrollment will be a minimum of 30 days from the date this form is submitted, in accordance with our contract. I acknowledge that I am responsible for the full four final weeks of tuition, less any applicable security deposit, regardless of my child’s last day of attendance. I understand that refunds will not be issued for unused days, and any credits must be applied toward services.
*
I agree
I acknowledge that failure to provide a full 30-day written notice of withdrawal will result in full tuition charges for that 30-day period and forfeiture of any security deposit. I understand that tuition remains due in full for the final four weeks, even if my child stops attending before the end of the notice period.
*
I agree
If my child’s tuition is paid by a third-party agency (e.g., CalWORKs, CHS, OC Dept of Ed), I confirm that I am providing them with the same last date of enrollment listed on this withdrawal form. I understand this form may be shared with my case worker or specialist to ensure accurate processing and documentation.
I agree
Intended Final Date of Attendance
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
At least 30-days from today
Parent's Full Name
*
First Name
Last Name
Parent's Email
*
example@example.com
Signature (digital signature)
*
Date of Signature
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Withdrawal Notice
Should be Empty: