Glen Rock Community School Before & After Care Change/Cancel Form
*One form per child must be filled out.
*Changes to Before and After care registration including withdrawals will have a $35 fee applied to your account.  Changes will take effect on the 1st of the month (or date after if the 1st falls on a weekend).
*Entry opportunities into the program are on the 1st  of the  month (or date after if the 1st falls on a weekend).
*Withdrawals made on or before the 20th of the month will go into effect the next month.
*Months are not prorated.
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Email *
First and Last Name of Child (one form per child) *
School Child Attends *
Parent's Name filling out the form and phone number *
We would like to cancel all of our days.
Clear selection
Reason for canceling, will be kept confidential. *
We would like to add these Before Care days.
Monday
Tuesday
Wednesday
Thursday
Friday
Before Care
We would like to add these After Care days.
Monday
Tuesday
Wednesday
Thursday
Friday
After Care
We would like to delete these Before Care days.
Monday
Tuesday
Wednesday
Thursday
Friday
Before Care
Reason for withdrawal from Before Care will be kept confidential. *
We would like to delete these After Care days.
Monday
Tuesday
Wednesday
Thursday
Friday
After Care
Reason for withdrawal from After Care will be kept confidential. *
Date these changes should go into effect. Entry opportunities into the program are on the 1st of the month (or date after if the 1st falls on a weekend).
MM
/
DD
/
YYYY
Submit
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