Notice of Withdrawal Form - DOC

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							                                  Notice of Withdrawal Form


I am submitting notice of withdrawal of my child /children ________________________ from Smiles &
Giggles Daycare.

The effective date will be _______________.

I ⁭ have ⁭ have not provided 2 weeks notification.

⁭ Deposit forfeited - not giving 2-week notice   ⁭ Deposit refunded on last day of child care.


Reason for Withdrawal:

________________________________________________________________________

________________________________________________________________________


Comments or Suggestions:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________



Parent or Guardian’s Signature: ___________________________ Date: _____________



Provider’s Signature: ___________________________Date: _____________