From Children’s Center at
Caltech
Child
Name:_________________________
Birthdate:___________________________
Group Name:__________________
Parent
Name:_________________________Phone:______________________
Leave
Starting:______________Expected Date of
Return:_________________
Reason
for Leave:_________________________________________________
I
understand that there is no guarantee that a space will be available when we
return. I understand that the space cannot be held in our absence. We will apply our initial deposit to our
last 30 days here and adjust our monthly contracted tuition rate accordingly. I
am attaching the check here.
Parent
Signature:_____________________________Date:_____________