Change Notification

Email

Effective Date of Change (MM/DD/YYYY)

First & Last Name(s) of all students affected by this Change Notification

Please select ONE of the following options.

I would like to CANCEL enrollment in Full-Time BEFORE Care

I would like to CANCEL enrollment in Full-Time AFTER Care

Comments or special circumstances

Please adjust the billing on my account to reflect the changes noted above. I understand that all monthly billing amounts will be pro-rated to the nearest HALF-MONTH.

Electronic Signature: Parent's permission is granted.

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ADD/CHANGE/CANCEL Notification

Use this form to initiate a change in your child’s Extended Care.

St. John the Evangelist School

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