Withdrawal / Termination Request

Cook Elementary BAS Program

Notice required: One month's written notice, given on or before the 1st of the month, is required to withdraw from the program. For example, if this form is received in November, the final month paid will be December, even if the child leaves before the end of December. Cancellations with less than one month's notice are non-refundable.

Withdrawal Details

School / Program

Reference Number

From your enrollment confirmation email. Optional but recommended.

Student Name *

Termination Effective Date *

The day on which you'd like care to end.

Your Email (for our reply)

Reason for Termination

Parent / Guardian Signature

Type your full legal name *

Typing your name above serves as your electronic signature for this termination request.

Date

I understand the one-month notice policy and accept that cancellations with less than one month's notice are non-refundable.

Complete required fields and acknowledge the notice policy to submit.

BAS Termination

Withdrawal / Termination Request

Withdrawal Details

Parent / Guardian Signature

Executive Director / CEO