Change of Days / Exit Questionnaire Form

Please select an option to continue (*):

Cancellation of Care

Change of Attendance

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Child/ren's Name:(*)

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Date:(*)

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I wish to cancel my child/ren’s enrolment to take effect from the following date:(*)

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Exit questionnaire. For reporting requirements, we would appreciate you completing the following if you are leaving the service (*) (Please check each applicable option):(*)

Cost of child care

No longer working

Change of employment /study /maternity leave

No longer living in the area

Commencing high school

Transfer to another service

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Other: (please provide a brief comment below).

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Please provide feedback on the service’s strengths

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Please provide feedback on areas the service could improve:

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Additional comments:

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Print Name:(*)

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Email Address:(*)

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Parent/Guardian signature:(*)

Sign Above

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Change of days/Exit Questionnaire

Change of Days / Exit Form