Summer Camp Change Form

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Notice of Fee Change, Temporary Absence or Withdrawal

If for any reason you decide to cancel a week for your child’s enrollment with the City of Peoria Summer Camp Program, written notification must be submitted no later than 12:00pm on Wednesday for the following week.

Please submit a form for each child. Complete the fields below and submit the form when completed. Please Note: If you wish to receive a copy of your request form, please enter your email in the box at the bottom of this page after completing the form.

Please correct the field(s) marked in red below:

Required Information


Attendance is based on a full week. There are NO daily rates and NO partial credits for days not attended during a scheduled week.
I would like to CANCEL a week of attendance: (please check box)
I would like to CANCEL a week of attendance: (please check box)


By submitting this form, I understand if my form is submitted after 12:00pm on the Wednesday prior, my cancel request will not be honored. I agree to abide by the policies and guidelines as originally stated.


In order to receive a receipt of this submitted form, you MUST fill in your email below.

  1. To receive a copy of your submission, please fill out your email address below and submit.