Rabun Kids Club: Afternoon Enrichment Program Student Withdrawal Form

Family Information
Guardian 1
Name*

First NameLast Name
Relation to student(s)*

FatherMotherGuardianOther
E-mail*
example@example.com
Prior Country of Residency*
Length of stay at ACME School*
Guardian 2
Name

First NameLast Name
Relation to student(s)

FatherMotherGuardianOther
E-mail
example@example.com
Child(ren)
Number of your children currently enrolled in the Rabun Kids Club: Afternoon Enrichment Program*
Child 1
Student's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Current Grade Level in School*
Effective withdrawal date*

MonthDayYear
Child 2
Student's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Current Grade Level in School*
Effective withdrawal date*

MonthDayYear
Child 3
Student's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Current Grade Level in School*
Effective withdrawal date*

MonthDayYear
Child 4
Student's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Current Grade Level in School*
Effective withdrawal date*

MonthDayYear
Child 5
Student's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Current Grade Level in School*
Effective withdrawal date*

MonthDayYear
Reason for Withdrawing from the Rabun Kids Club: Afternoon Enrichment Program*

Comments
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