Session a Cancellation
Please let us know at least 2 hours in advance of your scheduled session of cancellations so that scheduling arrangements can be made.
Date of Submission
Person Completing Form
Staff Name (Optional for Families)
Date to Cancel
Which Sessions are Cancelled?
Morning Session 8:30-11:30
Afternoon Session 12:30-3:30
Afterschool Session 4-6pm
If Multiple Days & Times, Please Note Below
Reminder of Cancellation Policy for Families
Attendance Requirement Percentage. If a learner is unable to attend at least 80% of the monthly recommended hours, the patient’s schedule will be faded by 50% of scheduled hours for the subsequent month. (Ex: If they are scheduled for 20 hours/wk, the next month they will be scheduled for 10 hours/wk). If the cancellations continue, the client’s services will be terminated and referred out. A full copy of the policy is available in the JHW Family Policy Handbook.
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