LEAP YDP - Withdrawal Form

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Thank you for taking the time to complete this withdrawal form and exit survey from LEAP Youth Development Program. We truly appreciate the opportunity we have had to work with your child/ren. The information gained will help us to continue to provide quality programming in the future. We appreciate and value your input.

~ LEAP Administration

Parent/Guardian Last Name *

Parent/Guardian First Name *

By typing my name below, I understand that a one week notice is required when withdrawing from the program and I am responsible for any tuition charges during this time period. *

Student/s last day of LEAP *

YYYY

What Site did your child attend LEAP Afterschool or Summer Camp *

Student/s Name (please list the first and last name of each child withdrawing from the program) *

What is the reason you are withdrawing from LEAP? *

My child enjoyed attending the program. *

Strongly Disagree

Strongly Agree

The program provided quality educational opportunities for my child. I was satisfied with the activities provided to my child by the program. *

Strongly Disagree

Strongly Agree

The program staff maintained open communication. They provided adequate information about my child and program activities. Rules and policies were clearly communicated to me. *

Strongly Disagree

Strongly Agree

I feel that the Site Director was visible and available when I arrive to pick up my child. *

Strongly Disagree

Strongly Agree

I feel that any concerns were handled appropriately and timely *

Strongly Disagree

Strongly Agree

Please share any additional comments, concerns and/or recommendations regarding the LEAP Youth Development Program.

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