Child Care Cancellation Form

1
Parent/Guardian Information:* This field is required.
First Name
Last Name
Please enter your phone
Please enter your email
2
Whose Child Care enrollment are we making changes to?* This field is required.
Child's full name
Child's date of birth
Please Select
Please Select
Yes
No
Do you have more children whose enrollment you'd like to change?
Which Program/school Is Your Child Enrolled in?
3
Whose Child Care enrollment are we making changes to?
Child's full name
Child's date of birth
Child's full name
Child's date of birth
Child's full name
Child's date of birth
4
Cancellation Reason* This field is required.
Cost
Loss of job
Moving
Found different care provider
Other
5
If you are currently receiving the 50% childcare membership discount, this will be removed with your child care enrollment. If you are intersted in applying for a scholarship to the YMCA centers, submit your form here.
6
My preferred last day/date of care is fill in date here . Please note we require two weeks written notice. Your care will be cancelled two weeks from when it is received.
7
Comments or Feedback for us? Tell us what you think!
8
I understand that I must provide a two-week advance written request for refunds because of vacation, cancellation, schedule change, or account information change. I understand that YMCA Child Care does not provide refunds if my child is suspended for any reason.* This field is required.Please sign below. Your account will be adjusted two weeks from the day we receive this submission, unless otherwise specified.
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