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2. 
3. To request a change in your current programming options or to drop from the program, please complete this form. You will be contacted within 48 business hours to verify your request. Must request a change a minimum of one week in advance.
5. Child's First and Last Name *
6. PreK Enrichment Location (School Name)*
8. Sibling's First and Last Name
9. CURRENT* Program Option*
   -- Select One --Before School onlyAfter School onlyAM or PM PreK Enrichment onlyPreK Enrichment & Before SchoolPreK Enrichment & After SchoolBefore/PreK Enrichment/After School

   Which program are you currently enrolled in?
11. Request*

    1. Change in current programming
    2. Drop from the program

    *One week advance notice required and a $15 change fee will be applied to your account per change.
12. Request Effective Date*
    Request Effective Date
    When would you like these changes to take effect? Fees paid run through Fridays. New programming request can start on Mondays.
14. Change To:*
    -- Select One --Before School onlyAfter School onlyAM or PM PreK EnrichmentPreK Enrichment & Before SchoolPreK Enrichment & After SchoolBefore/PreK Enrichment/After School
15. Are you receiving the 25% fee allowance? *

    1. Yes
    2. No
17. *Requests will be determined on program availability. You will be contacted within 48 business hours to verify your request.
19. Email Contact
20. Phone Number
22. Request Details:*
    Please list your programming change details here. For example, if you are currently enrolled in Before School Programming only and would like to add After School Programming as well, list that here.
24. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date 4) you agree to pay the $15 change fee

    1. I agree.
26. Electronic Signature
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field