Kindergarten Withdrawal/Deferral Form- Eastern

Kindergarten Withdrawal/Deferral Form
As per The Y Ballarat Policy, there is a withdrawal fee that will be applied to your account upon receipt of this completed form. The administration fee is $45.

A copy of our Fees Policy can be accessed on our website
Select the below that relates to you
Parent/Guardian Name

First NameLast Name
Child Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Select Kindergarten
Select Child's Last Attendance Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Reason for Withdrawing
Select how you would like to pay the withdrawal fee
Account name
Bank Name
BSB
Account Number
Email- Remittance advice will be sent to this email once payment has been provided
example@example.com
Signature
Should be Empty: