Withdrawal Form

withdrawal FORM

A prior written notice is required for any child/children leaving Elmhurst Learning Center for any reason

whether transferring to a new school, moving, graduation, vacation, ect. There is no vacation credit, since we

are a year round school. Should you fail to give a 30 day written notice parents/guardians understand that

they are fully responsible for a month of tuition. There is NO EXCEPTIONS to this policy.

Child's Name

First Name

Last Name

Child's Birthdate

Current Schedule

(Select One)

Full Day

Half Day

Potty Trained

Fully Potty Trained (With No Accidents)

Not Potty Trained

Withdrawal Date

YYYY

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone Number