UKids - East Village Withdrawal Form

Please note, a two (2) week notice is required when withdrawing your child from care. Please allow 1 business day for your notice to be received and an official confirmation of withdrawal to be sent to the email provided on this form.

Withdrawal Due to Financial Difficulty

If you are withdrawing due to financial difficulty, we ask that you please consider contacting the Student Parent Support Center (CCFR) office before submitting this form. There are options available for families with extenuating circumstances and the CCFR office may be able to assist you.

Contact Information

Child's First Name

Child's Last Name

Parent's First Name

Parent's Last Name

Parent's Email

Withdrawal Information

Last Day of Enrollment

Are you receiving a child care subsid (DWS, CCAMPIS, School Life Scholarship, etc.)?

YesNo

Comments:

Terms of Withdrawal

I understand that I am required to pay tuition to UKids – East Village equivalent to two weeks from receipt of this notice or through the last day of enrollment, whichever is greater.

I understand that any balance owed on my account must be reconciled with the center prior to my child’s last day and any questions I have regarding my ledger should be addressed with the center administration. Failure to reconcile any balance owed may result in my account being sent to collections, as noted in my service agreement.

I understand that upon receipt of this withdrawal notice my child’s disenrollment process will begin and that I will have a 2 business day grace period from the date my withdrawal is confirmed to change the last day of care. After this grace period a new application and fee must be submitted should I wish to re-enroll my child and that he or she will be placed back on the waitlist only when both the application and fee are received.

I have read and agree to the terms of withdrawal as stated on this form. I understand that my digital signature on this form is the legally binding equivalent of my handwritten signature.

Digital Signature

Today's Date

Contact Information