Child Care Withdrawal Form

Lets parents formally notify the center that they are withdrawing their child and state the reason.

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Name

Nombre

Apellido

Date of Birth

Registration Number (if applicable)

Parent/Guardian Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

Email Address

Date of Withdrawal Request

Last Date of Attendance

Reason for Withdrawal

Please provide any additional comments or feedback about your experience with our childcare program. Your input is valuable to us and can help us improve our services for other families.

Printed Name

Date

Signature

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Child Care Withdrawal Form

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