Teen REACH CANCELLATION REQUEST FORM

TEEN REACH CANCELLATION REQUEST FORM
PLEASE CHECK ONE:
For Days Out of School, please click the link to be redirected to a different form:

https://form.jotform.com/GJAY1785/doos-cancellation-req
Teen REACH School Site:
Teen REACH Summer Camp Location Site
How many children is this request regarding?
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
Regarding my Membership, I would like to:
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
Today's Date

MonthDayYear
Should be Empty:

TEEN REACH CANCELLATION REQUEST FORM