ST
1 -5
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Husky House, Inc.
SCHEDULE CHANGE REQUEST FORM FOR 2016-2017
This form should be used to request a permanent change to your child’s contracted schedule.
Please Note:
Ø This form must be received on or before the 15th of the month prior to the month in which
you want the change to be effective (i.e. by March 15th for the month of April).
Ø
Ø
Ø
Ø
Attach a check for $15.00 (per family) to process the change in schedule.
Late requests, unsigned requests and forms without a check for $15.00 will not be honored.
If decreasing hours, we cannot guarantee that we would be able to reinstate those hours in the future.
If requesting an increase in hours, it will be dependent on space availability in the requested time block(s). Failure to
submit a request for increased days/times by the 15th of the month prior may result in a need to request the time as an
“Add-on” on the appropriate form.
Ø An administrative staff member will call you with the approval status of the request as soon as it is approved or declined –
typically 1-2 days after the request is received. You will also receive a copy of this request with your new tuition amount
indicated in the “staff use only” section below.
Ø Once your request is approved, you will be charged for the time, regardless of cancellations.
Ø *add an extra $40 for early dismissal if using fewer than 5 days*
ê PLEASE INDICATE WHAT YOU WISH YOUR CHILD(REN)’S NEW SCHEDULE TO BE BY
X-ING IN THE BOXES BELOW:
Time Blocksà
2:42 – 4:00
7:30 – 8:15a.m.
2:42 – 5:00
2:42 – 6:00
Monday
Tuesday
*
Wednesday
*
*
*add an extra $40 for early
dismissal if using fewer than
5 days*
Thursday
Friday
Monthly Ratesà
(“days” are
per week)
5 days
4 days
3 days
2 days
1 day
$181
$146
$118
$80
$41
5 days
4 days
3 days
2 days
1 day
______________________________________
Child’s Name
$226
$183
$147
$100
$52
______
Grade
________________________________
Parent’s Signature
____________________
Telephone Number
5 days
4 days
3 days
2 days
1 day
$385
$314
$253
$172
$89
5 days
4 days
3 days
2 days
1 day
$543
$445
$358
$245
$124
_______________________
Effective Date (must be start of the month)
__________
Date
---------------------------------- STAFF USE ONLY ---------------------------------This Schedule Change has been:
Approved _________ Declined ________ Date ____________
Change Fee Rec’d/Charged___________ Put on Wait List __________ Copy Parent File ____________
New Monthly Tuition ____________ Tuition Adj. in OCS_____Schedule Updated (End of Month)____________
Ph.#(925) 283-7100
Fax#(925) 283-7104
www.huskyhouseforkids.org
Husky House, Inc.
KINDERGARTEN SCHEDULE CHANGE REQUEST FORM FOR 2016-2017
This form should be used to request a permanent change to your child’s contracted schedule.
Please Note:
Ø This form must be received on or before the 15th of the month prior to the month in which
you want the change to be effective (i.e. by March 15th for the month of April).
Ø
Ø
Ø
Ø
Ø
Ø
Ø
Ø
Ø
Ø
Attach a check for $15.00 (per family) to process the change in schedule.
Late requests and unsigned requests will not be honored.
If decreasing hours, we cannot guarantee that we are able to reinstate those hours in the future.
If requesting an increase in hours, it will be dependent on space availability in the requested time block(s).
Failure to submit a request for increased days/times by the 15th of the month prior may result in a need to request the time
as an “Add-on” on the appropriate form.
An administrative staff member will call you with the approval status of the request as soon as it is approved or declined –
typically 1-2 days after the request is received. You will also receive a copy of this request with your new tuition amount
indicated in the “staff use only” section below.
Once your request is approved, you will be charged for the time, regardless of cancellations.
*LATE Kindergarten add an extra $88 for Wednesday afternoon early-dismissal if using fewer than 5 days*
*EARLY Kindergarten add an extra $40 for Wednesday afternoon early-dismissal if using fewer than 5 days*
** Deduct $38 for Wednesday early start
ê PLEASE INDICATE WHAT YOU WISH YOUR CHILD(REN)’S NEW SCHEDULE TO BE BY
X-ING IN THE BOXES BELOW:
LATE Kindergarten options
Time
Blocksà
7:30 –
9:30
8:30 –
9:30
Monday
Tuesday
Wednesday
**
Thursday
Friday
Monthly 5 $380
Ratesà 4 $305
(days
per week)
3
2
1
$231
$156
$79
2:00 –
4:00
*
$153
$115
$78
$40
2:00 –
5:00
*
$380
$305
$231
$156
$79
2:00 –
6:00
______
$621
$507
$407
$275
$144
Parent’s Signature
12:45 –
2:30
$181
$146
$118
$80
$41
12:45 –
4:00
12:45 –
5:00
12:45 –
6:00
*
*
*
$267
$202
$137
$69
$556
$449
$363
$248
$127
$659
$539
$432
$293
$153
$809
$662
$528
$360
$186
_______________________
Grade
________________________________
7:30 –
8:15
*
$568
$458
$346
$235
$118
______________________________________
Child’s Name
EARLY Kindergarten options
____________________
Telephone Number
Effective Date (must be start of the month)
__________
Date
---------------------------------- STAFF USE ONLY ---------------------------------This Schedule Change has been:
Approved _________ Declined ________ Date ____________
Change Fee Rec’d/Charged___________ Put on Wait List __________ Copy Parent File ____________
New Monthly Tuition ____________ Tuition Adj. in OCS_____Schedule Updated (End of Month)____________
Ph.#(925) 283-7100
Fax#(925) 283-7104
www.huskyhouseforkids.org
Husky House, Inc.
TK SCHEDULE CHANGE REQUEST FORM FOR 2016-2017
This form should be used to request a permanent change to your child’s contracted schedule.
Please Note:
Ø This form must be received on or before the 15th of the month prior to the month in which
you want the change to be effective (i.e. by March 15th for the month of April).
Ø
Ø
Ø
Ø
Ø
Attach a check for $15.00 (per family) to process the change in schedule.
Late requests and unsigned requests will not be honored.
If decreasing hours, we cannot guarantee that we are able to reinstate those hours in the future.
If requesting an increase in hours, it will be dependent on space availability in the requested time block(s).
Failure to submit a request for increased days/times by the 15th of the month prior may result in a need to request the time
as an “Add-on” on the appropriate form.
Ø An administrative staff member will call you with the approval status of the request as soon as it is approved or declined –
typically 1-2 days after the request is received. You will also receive a copy of this request with your new tuition amount
indicated in the “staff use only” section below.
Ø Once your request is approved, you will be charged for the time, regardless of cancellations.
ê PLEASE INDICATE WHAT YOU WISH YOUR CHILD(REN)’S NEW SCHEDULE TO BE BY
X-ING IN THE BOXES BELOW:
LATE Kindergarten options
Time
Blocksà
Monday
Tuesday
Wednesday
Thursday
Friday
5
Monthly
Ratesà 4
(days
per week)
3
2
1
EARLY Kindergarten options
7:30 –
9:15
8:30 –
9:15
12:45 –
2:30
12:45 –
4:00
12:45 –
5:00
12:45 –
6:00
7:30 –
8:15
11:45 –
2:30
11:45 –
4:00
11:45 –
5:00
11:45 –
6:00
$317
$255
$206
$140
$72
$135
$109
$88
$60
$31
$267
$202
$137
$69
$556
$449
$363
$248
$127
$659
$539
$432
$293
$153
$809
$662
$528
$360
$186
$181
$146
$118
$80
$41
$420
$318
$216
$108
$659
$539
$432
$293
$153
$809
$662
$528
$360
$186
$958
$780
$627
$425
$221
___________________________________
Child’s Name
______
_______________________
Grade
________________________________
Parent’s Signature
____________________
Telephone Number
Effective Date (must be start of the month)
__________
Date
---------------------------------- STAFF USE ONLY ---------------------------------This Schedule Change has been:
Approved _________ Declined ________ Date ____________
Change Fee Rec’d/Charged___________ Put on Wait List __________ Copy Parent File ____________
New Monthly Tuition ____________ Tuition Adj. in OCS_____Schedule Updated (End of Month)____________
Ph.#(925) 283-7100
Fax#(925) 283-7104
www.huskyhouseforkids.org