SUMMER CAMP
NOTICE OF FEE CHANGE, TEMPORARY ABSENCE OR WITHDRAWAL

If for any reason you decide to change or drop your child's enrollment from the Peoria Summer Camp AM/PM Recreation Program, notification must be submitted by Thursday for the following week. You may use this form for notification. Please complete the form fields and submit the form when done.
 
*Parent's Name: *Child's First Name:
*School: *Child's Last Name:
*Email Address: *Home Phone:

*Required Fields

PLEASE CHECK ONE OF THE FOUR OPTIONS BELOW (changing-absent-inactive-withdrawing):

1. I will be changing fee contracts. (Please check the applicable days on your new program)

Effective Date of Change: 

Please 'X'
ALL DAYS ATTENDING 		Mon. Tue. Wed. Thu. Fri.
Daily Fee
($23 per day, $97 for full week)
Half Day Rate
This fee is only available for children registered in Peoria Unified School District Summer School Program
($15/day)
2. Will be absent beginning returning  for AM PM 1st Hour PM
3. Will be inactive until further notice, effective (date)
4. Will be withdrawing permanently, effective (date)
Reason for withdrawal:

Additional Information/Comments:

Check this box if:
I am currently scheduled on Quick Pay/EFT. Please charge my existing account according to the changes listed above. By submitting this form, I understand that I am amending my existing Quick Pay/EFT contract and agree to continue to abide by the policies and guidelines as originally signed.
 
 

By submitting this form, I understand that I am amending my existing Fee Attendance Contract and I agree to continue to abide by the policies and guidelines as originally signed.