Withdrawal Request Form

Parent Name(*)

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Student Name(*)

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Email Associated with the Account(*)

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Phone Number Associated with the Account(*)

Day of lesson(*)

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Time of Lesson(*)

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Swim Level(*)

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Last month swimmer will attend(*)

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Please read and accept the following:(*)

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.

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Common Reasons for Withdrawing That We Can Easily Address:

No progression - we can review the skills with their coach and supervisor to focus on what the swimmer needs to progress and give you a progress report at your next visit
Coach changing - all our coaches are GREAT! We can make sure to speak specifically about your student to their new coach (or sub) so they are fully prepared to focus on what your swimmer needs
Scheduling Conflict - we get it - it's hard to fit it all in! We can easily move your swimmer's set weekly time to best fit your schedule - OR - we can mark your student as absent and you can get a makeup - that way you keep your great spot and continue the important swim lessons!

Once this withdrawal is confirmed, the spot is not guaranteed open if you change your mind, or re-enroll in the future.

Reason for Withdrawal:(*)

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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.
Please note that all withdrawals are final. If you change your mind and want to stay in the program, you are welcome to re-enroll; however, availability in your previous class cannot be guaranteed.
All makeup tokens on the account will expire 7 days after your last day.

I understand that if I do not turn in the withdrawal form by the 18th of the current month, I will be charged for the entire subsequent month.

I have read & agree to the withdrawal policy(*)

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I understand by checking this box will serve as my electronic signature to the above agreement.(*)

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Today's Date(*)

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Electronic Signature (authorizing Atlanta Swim Academy to withdraw from the class indicated above)(*)

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Once the form has been submitted, you will receive a confirmation of your final day of lessons. This confirmation may be sent via email, text message, or phone call.

We will miss you in our program, but we warmly welcome you back whenever you are ready to re-join ASA. Just let us know, and we’ll be happy to help!

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