Child Care Withdrawal Disenrollment Form 2026

1. Click ‘Get Form’ to open the Child Care Withdrawal Disenrollment Form in the editor.
2. Begin by entering the Provider's name in the designated field. This identifies the center or in-home provider associated with your child’s care.
3. Next, fill in the Parent’s Name and Social Security Number (SS#) to ensure proper identification and processing of the withdrawal request.
4. List your Child(ren)'s Name(s) in the provided space. This is crucial for linking the disenrollment to specific children.
5. Indicate the Last Day of Attendance for Child Care. This helps establish a clear timeline for both parties involved.
6. If known, provide a Reason for withdrawal in the space provided. This can assist in understanding trends and improving services.
7. Ensure that both you and the Center/Provider sign at the bottom of the form, along with dating it to confirm submission.

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