Membership Freeze Request
Any member wishing to freeze their membership MUSt complete this form as documentation of the request. A request to freeze should be a minimum of 14 days.
Member/Child/Participant Name
*
First Name
Last Name
Guardian/Parent Name (if different than member/child)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date Freeze to Begin
*
-
Month
-
Day
Year
Date
Date Freeze to End
*
-
Month
-
Day
Year
Date
Medical Reasons?
*
Yes
No
Will you be traveling during the freeze?
*
Yes
No
If neither medical nor travel, what is the reason for the freeze?
Please explain
I understand that if I wish to resume my VSC activities early, before expiry of the freeze, I must notify the VSC Management so my account can be reactivated.
*
Yes
No
Member Signature
Submit
Should be Empty: