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STUDENTWITHDRAWALFORMIamherebyinformingChildDevelopment&LearningCenter(CDLC)ofthewithdrawalofmychild:
Child’sName:____________________________________________Teacher:___________________________________
ClassDays/Time:________________________________Dateoflastdaystudentwill/didattend:__________________
Iunderstandthatbycompletelyfillingoutthisformandpromptlyreturning/mailingittotheaddressbelow,IamofficiallywithdrawingmychildfromChildDevelopment&LearningCenter(CDLC),andthatanytuitionrefundduewillbemailed(seehandbookfordetails).
_____________________________________________ _________________________________________________Parent/GuardianName(pleaseprint) Parent/GuardianSignature
PleasereturntotheCDLCoffice,faxto952-898-9379,ormailto:
ChildDevelopment&LearningCenter13801FairviewDriveBurnsville,MN55337
ForOfficeUseOnly:DateReceived:_____________RefundDue?______________DateMailed:______________Amount:______________
ExitSurveySothatwemaycontinuetoimprove,andmakeinformeddecisionsaboutCDLC,pleasetakeamomenttoletusknowwhyyouhavewithdrawnyourchild.
Iamwithdrawingmychildbecause:
o Daycare/Workschedulingconflicts
o We’removing
o Costoftuition/monetaryconcerns
o Other:______________________________________________________________________________________