Parent Name*

First Last

Child Name*

First Last

Forwarding Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Last Date of Enrollment*

Primary Reason for Leaving

How would you describe your experience at Friendship Children’s Center?

What did you like best about Friendship Children’s Center?

What did you like least about Friendship Children’s Center?

If you could change any of the school’s policies or procedures, which ones would you change and why?

I have returned the following items to the Friendship Children’s Center:

I understand that we are being charged in full for the last month and that, because my family provided 60-days written notice of our enrollment termination, our security deposit will be refunded, less any outstanding tuition or fees.

I understand that I have the option to forgo the refund of my child's security deposit. By initialing here [_____], I am donating my child’s security deposit to FCC. Please send a tax receipt for the donation to me at the above address. FCC will process any security deposit refund due to me within one month of my child’s departure.

I understand that, in accordance with the school’s policy as stated in the Family Handbook, because 60-days written notice of our enrollment termination was not provided, our family is not eligible for a security deposit refund.

Parent Signature*

Family Separation Form