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PreK Enrichment CHANGE in Programming Request

  1. JCPRD Logo-3x3
  2. 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.
  3. Request*
    *One week advance notice required and a $15 change fee will be applied to your account per change.
  4. When would you like these changes to take effect? Fees paid run through Fridays. New programming request can start on Mondays.
  5. Are you receiving the 25% fee allowance? *
  6. *Requests will be determined on program availability. You will be contacted within 48 business hours to verify your request.
  7. 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.
  8. 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
  9. Leave This Blank:

  10. This field is not part of the form submission.