Year-End Statement Request

(2009 Year-End Statements Available Beginning January 22, 2010)

Today's Date: 3/14/2010

If your child or children currently attend a KinderCare Learning Center or you have withdrawn from a KinderCare Learning Center, please see the
Center Director to obtain your Year-End Statement.

Please complete this form ONLY if you are the parent or guardian of a child or children that attended a KinderCare Learning Center that is no longer open for business, or in the event the current Center Director is unable to furnish you with a copy of your Year-End Statement.

* Denotes a required field

Requester Information

*Tax Year Requested:

*First Name:

*Last Name:

*Mailing Address:

*City:

*State:

*ZIP:

*Phone:

Comments:

Center Information

*Mailing Address:

*City:

*State:

ZIP:

Your Children

Please include the first and last name for all children in your family that were enrolled for the tax year requested.

*First Name: *Last Name:

Distribution Information

*I certify that I am a parent or legal guardian of the above-listed child(ren), that the above information is accurate to the best of my knowledge, and that I am entitled to receive information regarding the total amount paid for tuition for the tax year: *

I wish to receive my year-end statement by email

Email:

I wish to receive my year-end statement by fax

Fax:

Please allow 7 business days to process your request.

As a service to our families, Knowledge Learning Corporation (parent company to KinderCare Learning Centers, Knowledge Beginnings, and CCLC) offers this Year End Statement to assist you in preparing your tax return. Our computerized records for 2009 show your total payments from 1/1/2009 to 12/31/2009 to be as stated above. These payments include fees and tuition, but may also cover services other than child care. Please make a copy of this statement for future reference regarding your child care payments for the year as this record may have limited availability. It is also suggested that you keep additional record of your payments such as copies of your checks or credit payments in order to provide primary proof of payment in the event of an external audit or inquiry.

If you have any questions with respect to this statement, please contact your Center Director.

Year-End Statement Request

Requester Information

Center Information

Your Children

Distribution Information

We appreciate your being part of our family!