Notice of Withdrawal form

Notice of Withdrawal header

I understand that I am required to provide two (2) weeks notice if I am to withdraw my child from this service.
I understand that I am to pay full fees for my child’s last day of attendance to the withdrawal date (all days not attended in the withdrawal period will incur the fee).
I understand that during this withdrawal period that I am required to pay full fees at this centre for the rest of the time period if my child attends another centre.

* All mandatory fields must be completed

Parent/Guardian Name: *

Details

Name of Centre: *

Child's Name: *

Family / Guardian Name: *

Home Phone

Mobile Phone *

Date Notice Given *

Child's last day at the centre *

Please choose a reason below: *

If other reason, please explain below:

FEE OR BOND TRANSFERS Any credits on your account, including bond payments will be used towards a final fee payment on your account. After your account is settled, your remaining bond or any fee credit will be refunded. REFUNDS BY EFT ONLY - PLEASE PROVIDE YOUR ACCOUNT DETAILS BELOW.
You will be issued with an invoice advising you of the balance of your account. This balance is to be finalised prior to your child’s last week at the centre.

Customer Name *

Contact Name & Phone Number *

Email *

Account Title: *

Bank Name: *

Branch Address:

Account Number: *

Branch Number (BSB): *

Name: *

Title:

AGREEMENT *

Date: *