Withdraw Form

WITHDRAW NOTICE

Todays Date

Parent Name

First Name

Last Name

I understand and acknowledge the withdraw policy for the program in which my child is enrolled.
Additionally, I acknowledge that any unpaid balances are due in full at time of withdraw and
agree to pay any additional fees incurred by Gym Like This! in the attempt to clear my account. I
understand that no refunds or credits will be applied after monthly payment processing has
occurred. See below for details

*Requires withdraw PRIOR to the processing the 25th of each month for Year Round Programs & 20th of each month for Competitive Programs.

Student Withdraw Information

Name of Child #1

Withdraw Date

Program

Class Day & Time

Reason for withdraw

Is there a second child?

Yes

Name of Child #2

Program of Second Child

Class Day & Time of Second Child?

Reason for Second child withdraw

Is there a third child?

Yes

Name of the third Child?

Program of the third child

Class Day & Time of Third Child?

Reason for third child withdraw

I understand my fees will be adjusted accordingly.