Event Withdrawal & Refund Application Form

GSA Event Withdrawal & Refund Application Form
Event Withdrawal & Refund Application – Key Information for Clubs

This Application Form is to be completed for any athlete withdrawing from an event run by Gymnastics SA.

Please complete one form per athlete per event.

Injury or Illness Withdrawals:
Submit this form with a certified medical certificate within 14 days after the event.
Late submissions will not be accepted or refunded.

Other Withdrawals (non-medical):
Submit this form at least 14 days before the event to be eligible for a refund.

Please ensure all forms are submitted on time to avoid ineligibility.

** Please note that withdrawals/refunds will be processed during the last week of the month
Please complete the below information.
Event*
If other, please specify
Event Date/s:*
Gymsport*
Club: *
Club Email:*
Name of athlete:*
Member ID#:*
Athlete/Parent Email:*
Parent Mobile Number:*
Reason for Withdrawal*

Injury/Illness (with medical certificate)Other (must be 14 days PRIOR to event)
Please provide details related to withdrawal*
Please upload Medical Certificate here: *

Cancelof
Notes or Comments
Name of Person completing this form*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Signature person filling out this form*

Clear
Should be Empty:

GSA Event Withdrawal & Refund Application Form