VLAA 2020-2021 Cancellation Form

*ALL SECTIONS OF THIS FORM MUST BE COMPLETED IN ORDER FOR YOUR CANCELLATION TO BE PROCESSED

Please refer to the 2020-2021 Before & Aftercare Parent Handbook for cancellation policies. The form must be completed and submitted to Program Director at least 2 weeks prior to effective date.

Select School

Primary Parent/Guardian*

Child/Participant*

Date of Birth* (mm/dd/yyyy)

Child/Participant

Date of Birth (mm/dd/yyyy)

Reason for Cancellation*

Last Day of Care* (mm/dd/yyyy)

PROGRAM FEEDBACK:
Please rate 1-Unsatisfactory to 5-Very Satisfied

Safety and Security

Communication of Program Information

Program Organiztion

Staff Engagement

Curriculum

Communication with Office

Would you recommend this program to a friend?

Yes No

Would you signup for this program again?

Yes No

Parent/Guardian E-Signature*

Today's Date* (mm/dd/yyyy)