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This form will cancel your swim lessons for the following month. Please note that you need to fill out all the fields required and complete the form for the cancellation to be processed.

First Parent of student or Student Name

First Name*

Last Name*
First Parent of student or Student Age Acknowledgment*
First Parent of student or Student Date of Birth*
I certify that I am 18 years of age or older
First Parent of student or Student Signature*
Second Parent of student or Student Name

First Name*

Last Name*
Second Parent of student or Student Date of Birth*
Third Parent of student or Student Name

First Name*

Last Name*
Third Parent of student or Student Date of Birth*
Fourth Parent of student or Student Name

First Name*

Last Name*
Fourth Parent of student or Student Date of Birth*
Fifth Parent of student or Student Name

First Name*

Last Name*
Fifth Parent of student or Student Date of Birth*
Sixth Parent of student or Student Name

First Name*

Last Name*
Sixth Parent of student or Student Date of Birth*
Seventh Parent of student or Student Name

First Name*

Last Name*
Seventh Parent of student or Student Date of Birth*
Eighth Parent of student or Student Name

First Name*

Last Name*
Eighth Parent of student or Student Date of Birth*
Ninth Parent of student or Student Name

First Name*

Last Name*
Ninth Parent of student or Student Date of Birth*
Tenth Parent of student or Student Name

First Name*

Last Name*
Tenth Parent of student or Student Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Please check the box
Location of lessons*
Please fill out the questions.
Reasons for cancellation:*
Medical Reason
Traveling/vacation
Moving
Busy schedule
Dissatisfaction
Financial
Other
Please select your over all satisfaction rating with our swim lessons.*
1- Very dissatisfied
2
3
4
5
6
7
8
9
10- Extremely satisfied

Comments.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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