Withdrawal Form
** Unenrollment date must be at least 30 days from the withdrawal application date per our policy, exceptions will not be made. You will not be charged nor will you be actively enrolled in any classes occurring on or after the Unenrollment date.
Parent's Full Name
*
Student's Full Name (Student 1)
*
Student's Full Name (Student 2)
Student's Full Name (Student 3)
Phone Number
*
Lesson Day/Time
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Lesson Day/Time
Lesson Day/Time
Email
*
** Unenrolled As Of Date (please see the red not above)
*
** Unenrolled As Of Date (please see the red not above)
** Unenrolled As Of Date (please see the red not above)
We strive to provide the highest quality experience for our families and students. Please kindly take a moment to provide feedback below (1 = lowest 5 = highest)
Swim Lesson Quality
*
1
2
3
4
5
Facility Cleanliness
*
1
2
3
4
5
Customer Service
*
1
2
3
4
5
Overall Experience
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1
2
3
4
5
Reason for Cancellation
*
By signing this form I am giving confirmation of my 30 day notice of enrollment cancellation at Blue Gems Swim School from the date of this withdrawal form. I understand that my final billing may be pro-rated if my final class occurs in the middle of a month. Also, I understand that any outstanding makeup classes must be used while actively enrolled (before the unenrollment date), are non-transferable and cannot be used in place of enrollment.
Signature (Your Full Name)
*
Today's Date
*
*
Required Fields