Teen REACH CANCELLATION REQUEST FORM

TEEN REACH CANCELLATION REQUEST FORM
TEEN REACH AFTER SCHOOL CARE PROGRAMTEEN REACH SUMMER DAY CAMPDAYS OUT OF SCHOOL
For Days Out of School, please click the link to be redirected to a different form:

https://form.jotform.com/GJAY1785/doos-cancellation-req
DirksenGompersHuffordWashington
Joliet Junior CollegeSalvation Army
123
Name of Child 1*
Name of Child 2*
Name of Child 3*
Cancellation Information
Reason for Cancellation*
Last Day of Attendance*

MonthDayYear
Date
Membership Information
Current Membership Type*
Keep ActiveCancelPut on Hold
How long would you like to be on hold? (You are able to reactivate earlier if you so choose.)*
Per the membership cancel/hold policy: I understand my membership dues may draft if this request is less than 10 days prior to my draft and/or I understand that my membership dues will draft after my hold period expires.
We would love to hear about the experience you and your child(ren) had in our Teen REACH program.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Signature*

Clear
Today's Date*

MonthDayYear
Should be Empty:

TEEN REACH CANCELLATION REQUEST FORM