Membership Cancellation Form

Membership Cancellation Form
We wish to cancel our membership with Melton Gymnastics Academy.
I First Name* Last Name* Parent / Guardian of First Name* Last Name*
Parent / Guardian Full Name

First NameLast Name
Gymnast Full Name

First NameLast Name
Email address
example@example.com
Effective From: Please note this must be the end a term

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please help us to improve our club by answering why you are cancelling your membership

Other
We would appreciate any additional feedback you can give us relating to why you are leaving
I understand I am still liable for all current outstanding fees;
Parrent / Guardian Signature
Should be Empty: