Change of Schedule

Student Information

Student's Last Name *

Student's First Name *

School *

Hearst

Grade *

I am currently signed up for: *

Please choose at least two days/week

I am adjusting my child's schedule, and I will need: *

Effective date of that change (please note that the office will not be able to accommodate changes with less than a 30-day notice). * +

Other services I would like to cancel

Before Care

Afterschool

Spanish

Art

Parent Information

Parent's First and Last Name *

Phone *

Email Address *

Date and Sign

Date * +

I hereby acknowledge that CLS’ policy requires 30-day notice. By submitting this form, I am notifying CLS that I will make a change for my child's schedule, and this change will happen in 30 days. Please sign. *

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