Daniel Gracie Freeze/Cancellation Form

Daniel Gracie Freeze/Cancellation Form
Freeze my MembershipCancel my Membership
Membership Information*

BRANCH LOCATIONMEMBERSHIP TYPE
Student Name*

First NameLast Name
Reason for freeze/cancellation (in paragraph)*
Financial situation, health related, staff issues, facility issues
How long have you been a member of Daniel Gracie Academy?*
Years
Phone Number*
Format: (000) 000-0000.
Membership Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Freeze/Cancellation Start Date*

MonthDayYear
Date
Freeze end date

MonthDayYear
Date
Terms and Conditions
- Cancellation will only be accepted via this form and not by phone or email.
- Since we do not require long term contracts, you have the right to cancel or freeze your membership at any time with a thirty (30) day notice.
- This means that you will provide notice of your cancellation 30 days prior to the next billing date. If you cancel less than 30 days prior to the next billing date, you will be billed for the next month.
- You will also still have access to the gym for the whole period paid.
- You must submit the form below and we will contact you with any missing information or a confirmation.
- Memberships may be frozen for up to 3 months per calendar year, for a month at a time.
- Members may not request to cancel their membership for the month directly following a freeze period.
- A membership must be active to request a cancellation.
Client's Signature*

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Date Signed*

MonthDayYear
Date
Should be Empty:

Daniel Gracie Freeze/Cancellation Form

Terms and Conditions