CHILD CARE CANCELLATION/CHANGE REQUEST

CHILD CARE CANCELLATION/CHANGE REQUEST

10-day written notice is required for cancellation or change requests for the Kid Zone Before and After School Program. Summer Camp cancellation or change requests must be received by the Wednesday prior to the camp week.
PLEASE CHECK ONE:*

KID ZONE BEFORE AND AFTER SCHOOL CARE PROGRAMTEEN REACH AFTER SCHOOL CARE PROGRAMSUMMER DAY CAMP
School District:*
Camp Program:*
How many children is this request regarding?*

1234
Name of Child 1*
School Attending*
Name of Child 2*
School Attending*
Name of Child 3*
School Attending*
Name of Child 4*
School Attending*
Summer Camp Location*
Current Kid Zone Plan*

1-2 days3-5 daysBeforeAfterBefore & After
I wish to:*

Cancel my registrationChange my registration
Program Cancellation
Reason for Cancellation*
Week(s) to Cancel: (select all that apply)

Week 1 - 6/5-6/9 (n/a for Avery 1/2 Day)Week 6 - 7/10-7/14Week 2 - 6/12-6/16Week 7 - 7/17-7/21Week 3 - 6/19-6/23Week 8 - 7/24-7/28Week 4 - 6/26-6/30Week 9 - 7/31-8/4 (n/a for Valley View)Week 5 - 7/3-7/7Week 10 - 8/7-8/11 (n/a for Valley View or Avery 1/2 Day)Other
Last Day of Attendance*

MonthDayYear
Date
Change Request
Change Effective Date*

MonthDayYear
Date
Reason for Change*
New Kid Zone Plan*

1-2 days3-5 daysBeforeAfterBefore & After
Current Membership Type*
Regarding my Membership, I would like to:*

Keep ActiveCancelPut on Hold
How long would you like to be on hold? (You are able to reactivate earlier if you so choose.)*
Per the membership cancel/hold policy: I understand my membership dues may draft if this request is less than 10 days prior to my draft and/or I understand that my membership dues will draft after my hold period expires.
We would love to hear about the experience you and your child(ren) had in our child care program.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Signature*

Clear
Today's Date*

MonthDayYear
Should be Empty:

CHILD CARE CANCELLATION/CHANGE REQUEST

Program Cancellation

Change Request