ELCA Young Chargers Enrichment Program
WITHDRAWAL FORM
Student's Name:
*
I wish to withdraw my child from the following week(s) of the Young
Chargers Enrichment Program. Cancellation penalty may apply.
WEEK of:
*
WEEK of:
*
WEEK of:
*
WEEK of:
*
WEEK of:
*
WEEK of:
*
WEEK of:
*
WEEK of:
*
Parent Signature
*
Date
*
-
Month
-
Day
Year
Date
Reason for withdrawal:
*
Submit
Should be Empty: