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Child Care Withdrawal Form Template

Easily outline your daycare withdrawal reasons with our template

Leaving a daycare can be stressful, especially when you need to communicate your reasons clearly. This Child Care Withdrawal Form Template helps you document your child's withdrawal in a professional way, ensuring you address everything necessary. With this template, you can easily specify withdrawal reasons, maintain good relations with your daycare, and streamline the process for both you and the staff. Plus, the form is aligned with best practices to respect your privacy and provide clear communication. Use this template to get started with ease.

Parent or guardian full name
Email address
Primary phone number
Relationship to child
Mother
Father
Legal guardian
Stepparent
Prefer not to say
Other
Please Specify:
Child full name
Child date of birth
Current classroom or program
Last date of attendance
Reason for withdrawal
Please Specify:
If other, please specify
I am providing the required notice per the policy
Yes
No
I acknowledge responsibility for any outstanding balances and applicable fees
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Preferred method for any refundable deposit or credit
Apply to final invoice
Refund to original payment method
Bank transfer
Mailed check
Hold as credit on account
Not applicable
Items being returned
Key fob
Access card
ID badge
Parking tag
Classroom materials
Nap bedding
Not applicable
Other
Please Specify:
Do you authorize us to share your child's records with a new provider upon written request?
Yes
No
New provider details (name and contact, if applicable)
Preferred method to receive withdrawal confirmation
Email
Phone call
Text message
Paper letter
No confirmation needed
What could we improve?
Parent or guardian signature (type full name)
Signature date
I certify the information provided is accurate and I am authorized to request withdrawal
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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colorful paper art illustration depicting a child care withdrawal form template and related elements

When to use this form

Use this form when a family plans to end care at your center, such as a move, a new work schedule, or a switch to preschool. It gives you formal notice, records the last day, and outlines refunds or final charges. Directors get clear staffing and waitlist timelines. Families get a simple process and a written record. If you need to validate the last week for billing, confirm hours against the Attendance form. If the family is moving providers, note how you will share health records kept in the Daycare medical form. The result is fewer surprises and a clean, documented handoff.

Must Ask Child Care Withdrawal Questions

  1. What is your child's last day of care?

    This sets the notice period and lets you plan staffing and classroom transitions. It also ensures billing stops on the correct date.

  2. Why are you ending enrollment?

    Your reason helps identify if a schedule change, classroom fit, or location issue is driving the decision. This guides whether to offer solutions now or improve for future families.

  3. Who is authorized to pick up your child and belongings on the final day?

    Clear authorization prevents confusion and protects safety. If needed, add pickup details using the Student sign out form.

  4. Do you need health or allergy records shared with a new provider?

    Selecting this tells us to prepare copies according to policy. You can request items we store in the Daycare allergy form and any medical records on file.

  5. What is your forwarding email, phone, and address for receipts and refunds?

    Accurate contact details ensure you receive tax statements, deposit returns, and any follow-ups. This reduces back-and-forth after your last day.

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