Information Update Form

Information Update Form
Type of Change Requested (please fill out all that applies)

Date Adjustments

Contact Information Update

Pickup Authorization Update

**Persons authorized to pick up child(ren) must be at least 18 years old**

Withdraw Request

** Withdraw Requests must be submitted to the Main Office by the 3rd of the month to end care at the end of the current month. Cancellations received after the 3rd will go into effect at the end of the following month. Tuition is not prorated and partial month refunds will not be given. **

Other Request

Signature