2023-2024 Extended Day Program (EDP), Integrated Pre-K & Mini Explorers Withdrawal Form
Please fill out all information accurately.

* Withdrawals are due on or before the 1st day of the month PRIOR to the month of withdrawal. 

Form Due:

August 1 for September 1 withdrawal
September 1 for October 1 withdrawal
October 1 for November 1 withdrawal
November 1 for December 1 withdrawal
December 1 for January 1 withdrawal
January 1 for February 1 withdrawal
February 1 for March 1 withdrawal
March 1 for April 1 withdrawal
April 1 for May 1 withdrawal
May 1 for June 1 withdrawal 

* Fill out one form per child.  
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Email *
Today's Date *
MM
/
DD
/
YYYY
Family Account # *
Family Account Name *
Child's Name *
Child's Grade *
I would like to withdraw my child from (check all that apply) *
Required
Program withdrawals must be received by the 1st of the month PRIOR to the month of withdrawal.
Example: If you wish to withdraw for the month of December, this form must be submitted no later than November 1st.  
Month of program withdrawal *
Required
Please read and check the boxes below: *
Required
Electronic Signature: By typing my name here, I agree to the above schedule change terms. (the name of person filling out form must match the names provided in Community Pass account) *
A copy of your responses will be emailed to the address you provided.
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