Membership Cancellation Request

Membership Cancellation Request
Each Mathnasium learning center is an individually owned and operated franchise entity. This cancellation request form is being submitted to the Mathnasium of Mukilteo.

Cancellation Policy Reminder

Thank you for the opportunity to serve your family. We are sorry to see you go. Should you decide to terminate your membership with us, please fill out and submit this form.



Please be reminded of our cancellation policy as follows:

Effective January 1, 2025:

·        All cancellations must be submitted in writing via this form in advance by 6pm Pacific Time on the 25th of the month prior to the 1st of the intended cancellation month.

·        Late request received between 6pm Pacific Time on the 25th of the month and 6pm Pacific Time on the 27th of the month prior to the 1st of the intended cancellation month will be processed with a $100 late fee.

·        Request received after 6pm on the 27th of the month prior to the 1st of the intended cancellation month will not be honored until the month after and will result in 100% payment requirement for the next billing cycle.

Future Re-Enrollment:

Effective 6/1/2022: Reassessment is required for any student who has not attended for more than 2 months upon re-enrollment. A $100 reassessment fee will be assessed.
Cancellation Request
Primary Guardian's Name*

First NameLast Name
Local Mathnasium Center that Your Children Attend*
Please contact your local center if you are NOT a client of Mukilteo
Email*
example@example.com
List of Students to cancel memberships:
Student 1 Name *

First NameLast Name
Student 2 Name (if applicable)

First NameLast Name
Student 3 Name (if applicable)

First NameLast Name
Intended Cancellation Effective Date*

MonthDayYear
Date - At least 3 business days in the future
Cancellation Reasons*
Please let us know why you are cancelling to help us improve our service.
Cancellation Statement

I hereby request to cancel my student's (or students') Mathnasium Membership by providing the minimum required notice period prior to the next billing cycle per the center's current cancellation policy. I agree to pay any outstanding balance and cancellation fees if applicable per our signed enrollment agreement. I authorize my payment method on file to be charged the applicable fees upon processing of this cancellation request.
Primary Guardian's Signature*
Today's Date*

MonthDayYear
Date
Please verify that you are human*
For Office Use:

Request Received Date: _____________________

Membership Level: o Elementary o Middle o High

Membership Type: o M-to-M o Long Term

Student Initial Enrollment Date: ___________________

Initial Enrollment Period Ending: ___________________

Cancellation Effective Date: _______________________

Cancellation Fees: _______________________________

Final Amount Due: _______________________________
Should be Empty: