Request class cancellation for members on 10 week tuition payment plan

If you are stopping your classes temporarily and plan to enroll again within 10 weeks, please fill out the Freeze request form.

If you are on 4 week tuition payment plan, please complete the 4 week tuition payment plan cancellation form.

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	* required fields
*Parent First Name
*Parent Last Name
*Email
*Phone
*Child First Name
*Child Last Name
	+ Add additional child
	- Remove additional child
*Child First Name 2
*Child Last Name 2
	+ Add additional child
	- Remove additional child
*Child First Name 3
*Child Last Name 2
	+ Add additional child
	- Remove additional child
*Child First Name 4
*Child Last Name 4
	+ Add additional child
	- Remove additional child
*Child First Name 5
*Child Last Name 5
*Reason for Cancellation:
*Initial to agree: As per my Membership Agreement, I understand I must submit this form a minimum of 2 weeks (before my 8th class) prior to my last class of this payment cycle, otherwise my cancellation will be subject to a $50 late cancellation fee.
*Additional Information
*We love feedback!! Please tell us your thoughts on our classes, schedule, teachers and/or pricing. Any information you provide will be used to make My Gym even better!
*Please prove you are not a Robot. What is 40 + 5