Withdrawal Form Parent Name* Student Name* Email Address* Day of lesson* Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time of Lesson* Swim Level* Private Lessons Shrimps Guppies Barnacles Seahorses Angelfish Otters Sea Turtles Flounders Triggerfish Sealions Manta Rays Dolphins Reef Sharks SwimFit Do not know level Last month swimmer will attend (must be next month if submitting after the 18th of the month)** Please let us know your reason for withdrawal. Remember that the ASA admin staff can help you with scheduling conflicts, instructor changes, and addressing class progression. We would love to hear feedback so that we can improve the experience for our swim families. Reason for Withdrawal* Scheduling conflict Traveling Moving Season Change/Weather Other sports/extracurricular activities No progression Not happy with instructor Cost of lessons Other (please specify in comments) Comments* Withdrawal Policy Please note the following: Withdrawal notice must be given on or before the 18th of the month to cease lessons by the end of the month. If this notice is not received on or before the 18th of your child’s final month, your card on account will be debited for the entire next month of lessons. Example: If your child’s last month to swim is June, please submit your withdrawal request no later than June 18th. All withdrawals are final. If you change your mind, you must re-enroll, but understand that space may no longer be available in that class. I understand that if I did not turn in the withdrawal form by the 18th of the month I will be charged for the entire subsequent month. I have read & agree to the withdrawal policy* I understand by checking this box will serve as my electronic signature to the above agreement.* Today's Date* Electronic Signature (authorizing Atlanta Swim Academy to withdraw from the class indicated above)* submit Thank you for filling out our Lessons Withdrawal form. We'll be in touch soon. Please turn on javascript to submit your data. Thank you!
