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Vacation Request Form
To receive a refund, this form must be received 5 business days BEFORE the requested date.
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Email
*
Your email
Child Information
For multiple children: Please indicate child's first and last name separated by a comma
Child's Name:
*
Your answer
Child's Site
*
Connections @ East High School
Requested Vacation Dates
Consistent Care Contract: receive 4-5 vacation credits per summer (based on days per week registered)
Pick Your Days Contract: receive 3 vacation credits per summer
1st Vacation Date Requested:
*
MM
/
DD
/
YYYY
2nd Vacation Date Requested:
MM
/
DD
/
YYYY
3rd Vacation Date Requested:
MM
/
DD
/
YYYY
4th Vacation Date Requested:
MM
/
DD
/
YYYY
5th Vacation Date Requested:
MM
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DD
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YYYY
Additional Comments:
Your answer
Parent/Guardian Information
I would like to receive my refund in the following way:
*
Stay on my account to use at a later date
Please take off my monthly bill
Refund my credit card on file
Parent/Guardian Signature
*
Your answer
A copy of your responses will be emailed to the address you provided.
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