subject_line
Withdrawal
Student Information
Student's Last Name
*
Student's First Name
*
School
*
Brent
Murch
Lafayette
Hearst
Grade
*
Pre-K
K
1
2
3
4
5
Service
*
Before Care
Afterschool
Extended Hours
Spanish
Art
Last day of your child
*
+
Is there any particular reason why you have decided to withdraw from the program? We would like to make sure we haven't disappointed you!
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 for terminating services. By submitting this form I am notifying CLS that I will withdraw my child from the program as indicated above. I will honor any outstanding payments on or before my child’s last day at CLS. Please sign.
*
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