DNSSAB | Formulaire de présense ou de retrait

Fee Subsidy

Withdrawal/Attendance Report

Please complete this report within 48 hours of being notified of a withdrawal.

This information is collected under the legal authority of the Child Care and Early Years Act, 2014 for administering the programs and services prescribed or authorized under this Act.

Yes, I give permission to store and process this data

Child Care Site Information

Attention to:

Ashley Piercey

Alexia Mathieson-Adams

Joel Gauthier

Marcelle Éthier

Derek McLeod

Name of Child Care Agency

Name of Staff completing the form

Email of staff completing the form

Withdrawal Information

Parent/Guardian Name

Name of Child/Children

Withdrawal Date

Reason for withdrawal and comments

(i.e. parent no longer working, parent no longer in school, parental leave, withdrawal without notice, etc.)

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