Program Change Request Form

(there is a $10 Change Fee per child)

Child(ren) Name and Age     Program Site

Phone Number                                   Effective Date of Change        

Other Sibling(s) in Kids Club?  Yes    No 

I have a current Credit Card Authorization on file: Yes    No Select Program Montessori Before and After Infants and Toddler Early Learning Center (3 and 4 yrs) Between Schools After School Before School Between Schools Closure Camps

My child is currently enrolled in      After School Before School Before and After School Between Schools Early Learning Center (3 & 4 yrs) Infants Montessori School Closure Camp Toddler Select Program Days of Week Select Number of Days Enrolled Currently 5 Days 3 Days 1 Day 5 Half Days (ELC) 3 Half Days (ELC) Other

I want to Type of Change Requesting CANCEL Program CHANGE Program CHANGE Payment Plan                      If CANCELING, tell us why Not needed at this time Why? New Childcare Work schedule change Unemployment Staff/Administration Tuition N/A Other Relocation

If requesting a change, please fill out below

I want to CHANGE my child to N/A Before School Before and After Infants or Toddler After School Early Learning Center Between Schools N/A 5 Days 5 Half Days (ELC) Other 3 Half Days (ELC) 3 Days 1 Day

I want to change my payment plan to N/A Regular Plan (Due on the First of the Month) Alternate Plan (1/2 tuition due on 1st and 1/2 due on the 15th)

Additional Information:

Any requests for changes and/or cancellations must be received in the Customer Service Center two business days prior to the date on which the change takes effect.  If a request is received with less than a two business day notice, the two days' tuition must still be paid.

I understand this form is only a request.  All changes are subject to availability, and submission of a Program Change Request Form does not indicate a change in program.  It is the responsibility of the parent/guardian to provide current enrollment information in order to be billed accurately. Please note that a $10 per child charge will be assessed to your account if decreasing your current program.

  I am requesting that my account be changed according to the above requests. 

  I authorize Kyrene School District to charge my credit card that is on file for any applicable charges for this request.  The last 4 digits of the credit card that is on file:

I will call Kyrene Customer Service at 480-783-4040 to give credit card information over the phone.

I am providing my email address to have a confirmation receipt emailed to me.

By placing my initials in the box I am agreeing to the terms set forth by Kyrene Community Education