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2022-2023 EDP & Kindergarten Extension & Pre-K Withdrawal Form
Please fill out all information accurately.
* Withdrawals are only processed on the 1st of the month
* 30 days notice is required for withdrawal.
* Fill out one form per child.
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Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Family Account #
*
Your answer
Family Account Name
*
Your answer
Child's Name
*
Your answer
Child's Grade
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Pre-K 3's
Pre-K 4's
Other:
I would like to withdraw my child from (check all that apply)
*
Extended Day Program (AM EDP Only)
Extended Day Program (PM EDP Only)
Extended Day Program (AM & PM EDP)
Kindergarten Extension
Integrated Preschool
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
*
September
October
November
December
January
February
March
April
May
June
Required
Please read and check the boxes below:
*
I understand that withdrawals are only effective on the 1st of the month, with 30 days advance notice.
I understand that I am responsible for the next month's tuition if 30 days advance notice is not given.
I understand that mid-month withdrawals are not refunded.
I understand the $25 registration fee is non-refundable.
I understand that once my child has been withdrawn from a program, I must re-register through Community Pass in order to return.
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)
*
Your answer
A copy of your responses will be emailed to the address you provided.
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