Summer Program Change Request Form

 

Child's Name and Age     School

Phone Number                            

 

My child is currently enrolled in     Early Learning Center    Kids Club (K-5)  Teens (6-8)  

 

I have a current Credit Card Authorization on file: Yes    No

 

     Please choose ONE OPTION per form

 

Option 1

    I WOULD LIKE TO ADD WEEK(S): (based upon availability)

   Days attending:    5 days a week          3 days a week:   M T W TH F
Option 2

 

    I WOULD LIKE TO DROP WEEK(S):

 

Option 3

 

(3 days per

week only)

                 

                   Change Days from:  M T W TH F

                   Change Days to:       M T W TH F

   FOR WEEK(S) OF:

 

As stated in the Program Handbook, to make changes to the program, the parent/guardian must provide written notice two weeks prior to the week being adjusted.  Summer Program Change Request/Cancellation Forms w ill be available through the Kyrene School District Office Monday through Thursday between 7:30 am and 5:00 pm( closed Memorial Day and July 4th) or online at www.kyrene.org/eservices.  Completed forms may be faxed to the Customer Service Center at 480-783-4141.  There is a $10.00 Program Change Processing Fee for each change for each child in the program.  It is the responsibility of the parent/guardian to provide current enrollment information in order to be billed accurately.  Processing fees and deposits are nonrefundable and nontransferable.

 

Additional Information:

 

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. (Changes to account will not be made until payment is received)

 

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

 

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