ELC Exit Form

A minimum of 2 weeks notice is required when submitting an Exit Form. It is a Centrelink requirement that the child attends their last booked day at the Centre.

Child Name Child Name First Last
Room
Last Day of Care Last Day of Care / DD / MM YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Mobile
Forwarding Address Forwarding Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Have you finalised payment on your account?

Have you finalised payment on your account? Yes No
How do you intend to pay this?
Reason for departure?

Reason for departure? Moving Financial Defence Transfer Starting School Other Other
Which school will the student be attending from now on?
Comments
Parent/Guardian Signature

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.