Child Care Change Form

Please use the form below to make a change to your child care schedule or cancel enrollment.

PLEASE NOTE: Canceling your Child Care registration does not cancel or suspend your membership. Please visit our Membership Change Forms page or visit our Welcome Center to cancel or change your membership.

If you have any questions about the child care program, please contact Katie Lizer at klizer@fspymca.org.

Parent/Guardian's Name: *

First

Last

Child's Name: *

First

Last

Please submit a separate form for each child.

Phone *

Email *

My child is enrolled in the following program:

Infant 5 Days
Toddlers 5 Days
Full Day 3s 5 Days
Full Day 4s 5 Days

1. Change Schedule

Changes to enrollment must be approved by the Director and received 15 days prior to the first of each month. Changes to your child's schedule are effective the first day of any month.

Change From:

To:

EXAMPLE: Toddler 4 days to Toddler 5 days

2. Cancel Enrollment

Deposits are non-refundable. If 45 days' written notice is provided, the deposit will be applied to the child's last month of enrollment.

Reason for cancellation:

Date change will begin:

I understand that canceling child care enrollment does not automatically cancel my membership and I need to complete a termination form (online or in person) if I want to cancel my membership. Please sign by entering your name below: *

Today's Date: *

Message

1. Change Schedule

2. Cancel Enrollment

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