Appointment Request Form

Coached Lessons Cancellation Form

- for private coached lessons scheduled at our Aquatic Centre -
Parent's Full Name (must be same name as you registered in Amilia with)*

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Swimmer's Name

First NameLast Name
Reason for Cancellation
Date of lesson needing to be cancelled*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date of lesson needing to be cancelled (2)*

MonthDayYear
Date
Hour MinutesAM/PM Option
Do you need to cancel more than 2 lessons?

Yes, please contact meNo, just the above lesson(s)
Anything else we need to know about this cancellation request?
By signing below and submitting this form, I understand that:
- The following policy will apply when canceling sessions in this program:
  - 100% of credit until 14 day(s) before the beginning of the activity
  - 70% of credit until 7 day(s) before the beginning of the activity
  - 50% of credit until 2 day(s) before the beginning of the activity
- Any applicable credit will be added back onto your Amilia account
- No credit will be available for appointments which are cancelled with less that 48 hours notice unless a doctor's note is provided. If a doctor's note is provided, 50% of the credit will be added back onto your account.
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Coached Lessons Cancellation Form