CHANGE OF ENROLLMENT REQUEST

Use this form if you are a currently enrolled family and you wish to change your child's enrollment status.

Please note that in order to transfer your child to another ChildRoots location you must fill out this form to request a transfer. Transfers are generally granted provided there is availablity. To withdraw entirely, ChildRoots requires 60 days notice.

Have questions? Contact Teresa our Enrollment Coordinator, or call (503)841-2753

CHILD INFORMATION

Name

First Name

Last Name

Child DOB

YYYY

Current Location

Current Room

REQUESTED CHANGE TO ENROLLMENT

Change enrollment by

Please note that to withdraw or diminish your enrollment in any way, we require 60 days advance notice. If date of preferred enrollment/withdrawal is less than 60 days you are still responsible for that full period of tuition.

School/location transfer

Withdraw

Start date of preferred enrollment or last physical date at school

YYYY

Comments and/or if applicable, reason for transfer or withdrawal:

PARENT CONTACT INFO

Parent Name:

First Name

Last Name

Phone

(###)

###

####

Further comments

May we use any feedback provided on our testimonials page?

5/25/2023 (SR)