Change of Schedule Form

 

 

CHANGE OF SCHEDULE FORM

(See Handbook for Policies & Procedures)

 

Child’s Name: ___________________________________________________________

 

School Site: _______________________________________   Program:    AM       PM

 

Type of Change

 Change of Days

 Adding Days

 Deleting Days

 Terminate/Inactivate

 Reactivate

 Vacation

 

 

PLEASE COMPLETE BELOW:

 

 

1.     Change is effective starting what date?    Week of:  ________________

 

 

2.     Is this a permanent change?      YES       NO

 

 

3.     If NO, please state date change is to be reversed back:  Week of:____________

 

 

4.     CURRENTLY, my child is attending: Mon   Tue   Wed   Thu   Fri

 

 

5.      My child will NOW be attending:                 Mon   Tue   Wed   Thu   Fri

 

 

NOTES:

 

 

 

 

 

 

 

 

 

 

 

Parent/Guardian Signature

 

Date

 

 

 

 

Site Director Use Only

 

Site Staff Initials:                                     Date Rec’d:                              

 

 

 

    Time Rec’d: