Child Care Withdrawal Form
Please complete to fully withdrawal your child from YMCA childcare. Withdrawal requests require a two weeks notice to ensure no additional billing or drafting occurs.
Child First Name *
Your answer
Child Last Name *
Your answer
Parent First Name *
Your answer
Parent Last Name
Your answer
Street Address *
Your answer
City, State Zip *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
School/Summer Camp Location *
Your answer
Reason for Withdrawal ( A $10 Administrative Fee will be invoiced for each Summer Camp week canceled.)
Your answer
Last Date of Attendance *
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DD
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I understand that withdrawal from our program requires a one week notice to ensure no additional billing or drafting occurs. *
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