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Milk Program Withdrawal Form
Please only complete this form if you need to withdraw your child from the Milk Program.
Please fill out this form for each child in your family.
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* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
Grade Level
*
2.9
K0
K1
K2
1
2
3
4
5
6
7
8
Parent First and Last Name
*
Your answer
I wish to withdraw my child from the Milk program effective the date below.
*
October 1
November 1
December 1
January 1
February 1
March 1
April 1
May 1
June 1
Other:
A copy of your responses will be emailed to the address you provided.
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