Continuous Enrollment Opt-Out Form

Continuous Enrollment Opt-Out Form

for 2027-2028 school year
Student(s) Name(s)
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Reason for Withdrawal
Statement of Withdrawal

I, the undersigned, hereby notify Awaken Christian Academy (ACA) of our intent to withdraw our student(s), from enrollment for the upcoming 2027-2028 academic year.

This notice is being submitted in writing before the January 20th deadline for withdrawal.

Should I choose to re-enroll our student(s) in the future, I understand that a $250 reinstatement fee (per student) will be applied.
I agree with the above statement
Date

MonthDayYear
Date
Signature
Should be Empty: