After School Change in Enrollment Form
Please submit this form if you require changes in the enrollment in the after school program. Changes will not be able to take effect until 2 weeks after the submission of this form.
If you have multiple children in the program, please submit one form per child.

Once the form is received by the After School Program Director, an email will be sent out within 48 hours confirming the last day of attendance and termination of the billing for the program or adjusted billing.

Student First Name
Your answer
Student Last Name
Your answer
Grade for 2016-2017 School Year
I wish to add the following days starting 2 weeks from today (check all that apply):
Please list the effective date of the addition of days to the after school program:
MM
/
DD
/
YYYY
Include any notes about adding days to the program.
Your answer
I wish to drop the following days starting 2 weeks from today (check all that apply):
Please list the effective date of the dropping of days to the after school program.
MM
/
DD
/
YYYY
I wish to withdraw my child from the After School Program effective 2 weeks from today:
Include any notes about dropping days from the program.
Your answer
Parent First Name
Your answer
Parent Last Name
Your answer
Parent Email Address
Your answer
Today's Date
MM
/
DD
/
YYYY
Submit
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