Early Childhood Change Request

Stephanie Walsh, Early Childhood Director
swalsh@jccns.com | 857-285-7924

Brianna Lapointe, Assistant Director
blapointe@jccns.com | 857-285-7926

Administrative Assistant
857-285-7919

Fields marked with an * are required

Parent/Guardian First Name *

Parent/Guardian Last Name *

Child's Full Name *

Child's Birth Date *

Email *

Confirm Email *

Current Schedule (days & times) *

Requested Schedule (days & times) *

Date that requested schedule will take effect: (30 days notice required for decreasing hours.)* *

Please use credit card on file for updated charges *

TERMS OF ACCEPTANCE and SIGNATURE Electronic Signature* *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *

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