ESage Schedule Request
**** This form is NOT to enroll for ESage. Please complete a Registration form, which is at the top of our website. ****

SCHOOL YEAR 2023/24 CREDIT POLICY:

For School year ESage, form must be submitted TWO WEEK PRIOR to drop in or cancellation to receive credit. Drop ins are subject to availability.
For summer ESage, form must be submitted TWO WEEKS PRIOR to drop in or cancellation to receive credit.
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Withdrawal Policy:
To withdraw your child from the ESage program, a Schedule Request Form must be submitted at least TWO WEEKS in advance of the intended final day of attendance. Final payment will be prorated for a partial billing cycle.
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Email *
Child's Last Name *
Child's First Name *
Grade *
I would like to cancel a day
Schedule Start (first day of absence)
MM
/
DD
/
YYYY
Schedule End (last day of absence)
MM
/
DD
/
YYYY
I would like to give more detail about my submission
I would like to add a day   * * * Drop Ins or Adding additional days are always dependent on space being available. Additions are not confirmed until you receive an email confirmation from the ESage Coordinator. * * *
Schedule Start (first day of drop in/ day(s) added)
MM
/
DD
/
YYYY
Schedule End (last day of drop in/ day(s) added)
MM
/
DD
/
YYYY
I would like to give more detail about my submission
I would like to cancel my enrollment in the ESage Program. My child(ren)'s last day of attendance will be:
Parent/Legal Guardian Signature *
A copy of your responses will be emailed to the address you provided.
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