Care Termination Form

Date_______________________________.

Dear __________________________________________________________________,

Please accept this letter as notice of termination of care for

___________________________.

Care is terminated effective __________________

Reason Given:

[ ] Violation of contract or parent handbook.

[ ] NSF Checks

[ ] Parent/Provider Differences

[ ] Child Behavior

[ ] Other ____________________________________________________________

_______________________________________________________________________.

Notice Given

[ ] As per our contract agreement, I am providing a _____ week notice and last day of

care will be _________________. Your $_______ deposit will be credited towards your

last fee due on __________________________________.

[ ] Immediate Termination, your Deposit [ ] WILL [ ] WILL NOT be refunded.

I wish you and your family all the best.

Sincerely,

___________________________________________

Provider

________________

Date

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Parent category: Legal