Notice of Withdrawal Form | UCLC | University of North Dakota

Parent/Guardian is required to complete and submit this form to UCLC a minimum of one (1) month prior to child's last day of care.

Parent/Guardian Name*

Parent/Guardian ID Number

This is the UND ID Number that gives you access to Campus Connections to pay your bill.

Child's Name*

This is to give notice that my child will withdraw from the University Children's Learning Center. I understand that I will be billed for the child care tuition for one (1) month past the signature date of this form or the last day of scheduled care, whichever is longer.

I intend for my child's last day of attendance to be*

Reason for Withdrawal

You may request that your child be placed on an internal waiting list to return to the Learning Center at a later date. Your signature indicates that you understand that your child is on a waiting list and a returning opening is not guaranteed to be available.

I want to place my child on the internal waiting list

Yes
No

If yes, what return date do you request?