* Required

WITHDRAWAL FORM

Full Name of Parent/Legal Guardian:required

New Home Address:

Address 1required

Address 2

Cityrequired

State

Ziprequired

Countryrequired

Phone Numberrequired

Parent's Email Addressrequired

Name and Address of school student is transferring to:

Name of new school:required

Address 1required

Address 2

Cityrequired

State

Ziprequired

Countryrequired

I hereby withdraw my child(ren) from GISNY:

Child 1

First Namerequired

Last Namerequired

Graderequired

Enrollment Child 1 at GISNY

fromrequired (mm/dd/yyyy)

First day at GISNY

torequired (mm/dd/yyyy)

Last day at GISNY

Add another child to be withdrawn*

Yes No

Child 2

First Namerequired

Last Namerequired

Graderequired

Enrollment Child 2 at GISNY

fromrequired (mm/dd/yyyy)

First day at GISNY

torequired (mm/dd/yyyy)

Last day at GISNY

Add another child to be withdrawn*

Yes No

Child 3

First Namerequired

Last Namerequired

Graderequired

Enrollment Child 3 at GISNY

fromrequired (mm/dd/yyyy)

First day at GISNY

torequired (mm/dd/yyyy)

Last day at GISNY

MEMBERSHIP IN THE GISNY CORPORATION:

PARENT/GUARDIAN 1*

I would like to CONTINUE my membership. I would like to CANCEL my membership at the end of the current school year.

Namerequired

Full Name of Parent/Guardian 1

Emailrequired

Email Address of Parent/Guardian 1

An invoice for the annual membership dues will be send to you in the beginning of the school year.

PARENT/GUARDIAN 2*

I would like to CONTINUE my membership. I would like to CANCEL my membership at the end of the current school year.

Namerequired

Full Name of Parent/Guardian 2

Emailrequired

Email Address of Parent/Guardian 2

An invoice for the annual membership dues will be send to you in the beginning of the school year.

We would very much appreciate your feedback about your reasons for leaving the school. We will be raffling a special prize for those that complete the survey for departing families. The raffle will take place June 15^th of each school year. To access the survey, please click on the link below. The survey can be submitted anonymously.

https://www.surveymonkey.com/r/departingfamilyquestionnaire

Signaturerequired

Daterequired (mm/dd/yyyy)

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :