Withdrawal Form
Must be received no later than 30 days prior to first day of the month you intend to stop swimming.

Example:
A Cancellation received on February 1st - Withdrawal will be effective March 1st.
A Cancellation received after February 1st - Withdrawal will become effective April 1st.

100 Skyway Drive, San Jose, CA 95111
(408) 513-2450 (OFFICE) (408) 513-2451(FAX)

Swimmer First & Last Name *
Your answer
2nd Swimmer First & Last Name
Your answer
3rd Swimmer First & Last Name
Your answer
Parent First & Last Name *
Your answer
Email *
Your answer
Effective On *
MM
/
DD
/
YYYY
Reason For Withdrawal *
Required
Further Explanation (Only if other was selected for reason above)
Your answer
*
Required
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