103 Club Permanent Schedule Change Form
Please use this form to make permanent 103 Club schedule changes.  In addition to filling out this form, please send a note to your child's classroom teacher on the first day of the schedule change. Once you submit your form, you will only be contacted if the change CAN NOT be accommodated. You will not receive a confirmation. 
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Email *
Child's Name *
Child's grade *
Current Schedule *
Starting date of schedule change- (two week notice required) *
MM
/
DD
/
YYYY
New Schedule (check all that apply, minimum 2 days)
Monday
Tuesday
Wednesday
Thursday
Friday
No longer attending **
AM
PM
If your child is no longer attending, your default will be changed in PikmyKid. Please choose what you want that to be.
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Comments:
A copy of your responses will be emailed to the address you provided.
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