2023-2024 School Age Child Care Change Form

Parent/Guardian's Name: *

First

Last

Child's Name: *

First

Last

Please submit a separate form for each child.

Phone *

Email *

1. Change to Schedule

Changes to your child's schedule must be made by the 20th of the month prior.

Effective Date Begin:

Effective Date End:

Change to schedule:

Change from full care to partial care (4:30pm dismissal, 5 days only)
Change from partial care to full care (6:30pm dismissal)

If changing to full care (6:30pm dismissal), choose the number of days your child will be attending:

Two (2)
Three (3)
Five (5)

Please note: If a spot is not currently available in our after care program, you will be placed on a wait list and notified when a spot becomes available.

If you selected the two (2) or three (3) day option above, please indicate which days you would like to enroll

Please note: We will do our best to accommodate those who choose our 2 or 3 day care option. Changes are not active until you receive a confirmation email from the program director. If a spot is not currently available in our after care program, you will be placed on a wait list and notified when a spot becomes available.

2. Change Days

Changes to your child's schedule must be made by the 20th of the month prior. Please note: we suggest families choose permanent days for the entire school year, and will do our best to accommodate day changes for those who choose our 2 or 3 day care option. Changes are not active until you receive a confirmation email from the program director.

I would like to change my days to (check all that apply):

3. Cancel Enrollment

Deposits are non-refundable. If 30 days' written notice is provided, the deposit will be applied to the child's last month of enrollment. If 30 days' notice is not provided, a credit will be applied to your account that can be used for other programming.

Reason for cancellation:

Effective Begin Date:

Effective End Date:

4. Select Membership Option

If you are canceling After Care enrollment, please select the following:

I would like to keep my family membership active and agree to pay the full family rate (currently $105 per month) on the 1st of each month.
I would like to change to a youth membership and will continue to pay the youth rate (currently $33 per month) on the 1st of each month.
I would like to cancel my membership.

Today's Date: *

I understand that changes are not active until I receive a confirmation email from the School Age Child Care program director. I understand that canceling after care enrollment does not automatically cancel my membership and I need to select an option above or complete a termination form if I want to cancel my membership. Please sign by entering your name below: *

1. Change to Schedule

2. Change Days

3. Cancel Enrollment

4. Select Membership Option

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1. Change to Schedule

2. Change Days

3. Cancel Enrollment

4. Select Membership Option

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Main Facility Hours