Parent Withdrawal Form (Page 2 of 2) in pdf

Parent Withdrawal Form Page 2

Parent Withdrawal Form

As a reminder:



Parent Withdrawal Forms are to be filled out in pen only.



This Parent Withdrawal Form is required to be filled out and submitted with a

minimum of TWO WEEKS’ notice in order for a client to withdraw and cancel our

agreement.



Parent Withdrawal Forms are accepted only on Fridays that the daycare is “OPEN”



Parent Withdrawal Forms will not be valid or accepted on days that the daycare is

“CLOSED” such as holidays or during the child care provider’s vacation.



The final two weeks’ period cannot overlap the child care provider’s vacation.



to be accompanied by any final payment(s) IN

Parent Withdrawal Forms are

FULL such as child care and penalty fees (if any).



The security deposit will be used towards paying for the child’s final two

weeks of childcare providing that a proper written two week notice was given.

CHILD CARE PROVIDER USE ONLY

 GIVEN

 NOT GIVEN

Two Weeks’ Notice

 APPLIED

Deposit used for last 2 weeks

 N/A  $___________  PAID DATE __________

Amount Still Owed

 N/A  PAID $_______________ DATE __________

Refund Owing (if prepaid)

Helping Hands Childcare * 1225 Nilgai Place * Ventura CA 93003 * 805-323-6860

Parent Withdrawal Form Page 2