Cancellation Form

First Name

Last Name

Address

City

Postal Code

Home Phone

Mobile

Email Address

Swimmer #1 Name

Swimmer #1 Date Of Birth

Swimmer #2 Name

Swimmer #2 Date Of Birth

Swimmer #3 Name

Swimmer #3 Date Of Birth

Lesson Day
(select all that apply)

Lesson Time
(select all that apply)

Morning

Afternoon

Evening

Reason for cancelling
(select all that apply)

If you selected "other" above, please fill in here:

If you selected 'schedule conflict' above please let us know preferred day & time

Date Of Last Lesson (must give 30-day notice)