Summer Vacation Request Form - 2021

Child’s Name ___________________________________________ 2020/21 Grade _________

Parent/Guardian ________________________________________ Phone:________________

Adventure Club Site (circle one):

STAFF USE ONLY

Processed by: _______________________________________

Vacation days to be granted for the equivalent of 2 weeks of your contracted schedule and must

be used a week at a time.

Vacation Request Form is due to the Adventure Club site by the 15th of the prior month in which

you are requesting vacation. Forms submitted after 15th are not accepted. Any dates

requested but attended subsequently will be added back onto account as added care. Tuition is

charged for missed days without prior vacation approval.

Kaseberg Quail Glen Riego Creek Stoneridge Vencil Brown Woodbridge

I am requesting vacation from my scheduled care for the following dates:

__________________________________________________________

Number of days: ______________________

Comments (optional) : ___________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Parent Signature __________________________________________ Date ________________

Staff Signature ____________________________________________ Date ________________