Disenrollment

Disenrollment

Complete the form below if you have a child that is no longer present at your site.
Please note that this form should only be completed for a child receiving subsidy through The Rutgers Southern Regional CCR&R.

* Indicates required field

The County in Which Your Site is Located *

Your Name or Name of Business *

Child's Name *

First

Last

Guardian's Name *

First

Last

Family ID *

Last Date Child Attended *

Reason for Disenrollment *

Your EPPIC ID *

Submit