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2. 
3. To request a change in your current programming option (currently Full Time, Before&After School Care) or to drop from the program, please complete this form.
5. Child 1 - First and Last Name *
6. OST Location (Elementary School Name)*
8. Child 2 - First and Last Name
9. Child 3 - First and Last Name
11. Request*

    1. Change in current programming (currently Full Time, Before & After School Programming)
    2. Change in current programming (currently Part Time, Before & After School Programming)
    3. Change in current programming (currently Full Time, Before School Only Programming)
    4. Change in current programming (currently Part Time, Before School Only Programming)
    5. Change in current programming (currently Full Time, After School Only Programming)
    6. Change in current programming (currently Part Time, After School Only Programming)
    7. Drop from the program

    *One week advanced notice required and a $15.00 change fee will be assessed to your account per change.

12. Request Effective Date*
    Request Effective Date
    When would you like these changes to take effect? (Fees paid run through Fridays. New programming requests can start on Mondays.)
14. Change To:*
    -- Select One --BEFORE School Program FULL-TIMEBEFORE School Program PART-TIMEAFTER School Program FULL-TIMEAFTER School Program PART-TIMEBefore & After School Program FULL-TIMEBefore & After School Program PART-TIMEDROP from program complelety

    Requests will be determined by program availability.

15. Are you currently receiving the 25% fee allowance?*

    1. Yes
    2. No
17. Email Contact*
18. Phone Number
20. Request Details:*
    Please list your programming change details here. For example, if you are currently enrolled in Before School Programming only and would like to add After School Programming as well, list that here.
22. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 4.) You agree to pay the $15.00 change fee.

    1. I agree.
24. Electronic Signature
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field