Withdrawal Form
**Please note all requests need to be submitted before the 15th in order to avoid your account being charged another month.

For example if my child's last month of lesson was the month of May, please submit your withdrawal request by May 15th.
Sign in to Google to save your progress. Learn more
Which subscription track are you wanting to withdrawal from? *
Parent's Name *
Swimmer's Name *
Email associated with the account *
Phone number associated with the account *
Last 4 digits of the credit card associated with this account. (If the numbers on file do not match we will call you) *
What class day/time are you cancelling? (i.e. Monday's @ 4:00PM) *
Select the last month of lessons your child will be swimming with us? *
Please select your reason for withdrawal *
Clear form
Never submit passwords through Google Forms.
This form was created inside of CITY OF OREM. Report Abuse