Summer Camp Cancellation Request Form

Summer Camp Request For Change Form

Below is IC3's Summer Camp Request For Change form. As we know, life happens and plans can change. If you need to cancel any and/or all weeks of Summer Camp for your child, please complete the form below. * REFUNDS ONLY GRANTED IF WE HAVE A WAITLIST FOR THE WEEK YOU ARE UNENROLLING AND WE ARE ABLE TO SUCCESSFULLY FILL THE SPACE. ** If you have any questions regarding IC3 Summer Camp please call 607-257-0200.

Child's Name*

Child's Name

First Last

Parent's Name*

First Last

Email*

Email

Please select the week(s) you are requesting to unenroll from:*

Please select which week(s) you are requesting to unenroll.

Reason for unenrolling from IC3's Summer Camp Program*

Please provide a reason for your unenrollment from IC3's Summer Camp Program.

If your refund is approved, how would you like to receive it?*

Please select how you would like to receive your refund if approved.

Applied To Account For My Child/ Other Child
Mailed to Address
Pick Up At IC3
Donate My Week To Another Family

Address

Street Address Address Line 2 City State ZIP Code

Please enter your mailing address where you would like your check mailed.

Child's Name

What account would you like your fees applied to?

First Last

Phone

This field is for validation purposes and should be left unchanged.

Summer Camp Cancellation Request Form

Summer Camp Request For Change Form

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Ithaca Community Childcare Center