Bay District Schools
1311 Balboa Avenue 
Panama City, Florida 32401 

Attn:  The Superintendent of Schools
Re:  Notice of Termination Of A Home Education Program

In compliance with Section 232.02(4)(B)(1), Florida Statute, this serves as 
the written notice of termination from our home education program.  The 
following will be withdrawn:


Child's Name (Please Print Clearly):                     Birth date:

1. _____________________________________________  	_______________

2. _____________________________________________  	_______________

3. _____________________________________________  	_______________

4. _____________________________________________  	_______________

5. _____________________________________________  	_______________

6. _____________________________________________  	_______________


Home Address:	__________________________________________________

               __________________________________________________



__________________________________
Parent’s Name (Please Print)

__________________________________
Parent Signature

__________________________________
Date of Termination