Cancellation Form

*ALL SECTIONS OF THIS FORM MUST BE COMPLETED IN ORDER FOR YOUR CANCELLATION TO BE PROCESSED

Please refer to the Parent Handbook for cancellation policies. The form must be completed and submitted to Program Director at least 2 weeks prior to effective date.

Select Your Schoolrequired

Primary Parent/Guardianrequired

Full Name

Child/Participantrequired

Full Name

Date of Birthrequired

Must contain a date in M/D/YYYY format

Child/Participant

Full Name

Date of Birth

Must contain a date in M/D/YYYY format

Program InformationrequiredSelect One

Before Care

Aftercare

Winter Camp

Spring Camp

Summer Camp

Select One

Reason for Cancellationrequired

Last Day of Carerequired

Must contain a date in M/D/YYYY format

PROGRAM FEEDBACK:
Please rate 1-Unsatisfactory to 5-Very Satisfied

Safety and Security

Single Choice

1

2

3

4

5

Communication of Program Information

Single Choice

1

2

3

4

5

Program Organiztion

Single Choice

1

2

3

4

5

Staff Engagement

Single Choice

1

2

3

4

5

Curriculum

Single Choice

1

2

3

4

5

Communication with Office

Single Choice

1

2

3

4

5

Would you recommend this program to a friend?

Single Choice

Yes

No

Would you signup for this program again?

Single Choice

Yes

No

Parent/Guardian E-Signaturerequired

Today's Daterequired

Must contain a date in M/D/YYYY format

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Cancellation Form