Group Level Class Withdrawal Form
One form per student per class
*Form must be submitted before close of business on the last working day of the month, including holiday closures, as your end date may affect your monthly billing.
Day of class:
Time of class:
Do not know level
Kids Zone Day Care
Date of Last class (must be at least 30 days from today's date, or 4 lessons advance notice):
(Authorizing Atlanta Swim Academy to WITHDRAW FROM the class indicated above)
I understand that I forfeiting my space in this class by signing this form.
A written withdrawal notice of at least 30 days is mandatory to withdraw from lessons; otherwise, we will assume you want to continue with lessons and the credit card on file will be automatically debited on the 1st of each subsequent calendar month.
I understand that if I am completely withdrawing from lessons (Group or Private) and I fail to give the mandatory 30 day withdrawal notice a $30.00 EARLY WITHDRAWAL FEE will be charged.
I understand that once my withdrawal has been submitted I am no longer able to change my class day or time.
I understand by checking this box will serve as my electronic signature to the above agreement.
I have read & agree to the Withdrawal Policy.
I would like to pay the Early Withdrawal Fee and withdraw as of today. (This fee can alternatively be deducted from any credit you have remaining from unattended prepaid classes for the month if applicable.)
Yes, please charge my credit card listed below the $30 Early Cancellation Fee
Name on Card
Credit Card Type
Credit Card Number
Expiration Date (mm/yy)
(Authorizing ASA to charge my card)
Reason for Withdrawal or General Comments: