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Membership Cancellation Request Form- Evolve Studio NS

 

In-Person Request for Membership Cancellation:

I understand that my in-person execution of this Membership Cancellation Request will act as my official request to cancel my membership prior to it's renewal date, or to buy out my existing monthly membership with Evolve Studio Northshore. 

I further acknowledge, as outlined in my Membership Contract, that in-person execution of this Membership Cancellation Request Form must be received at least 30-days prior to the next scheduled draft date to terminate the membership (the notification period). The 30-day notice period begins on the date of in-person signature on this form. 

Buy Out:

This Membership Cancellation Request notice is required to be signed, in-person at the studio, at least 30-days prior to the next scheduled draft date to terminate this membership. The 30-day notice period begins on today's date (the day the in-person signature is received). If the next draft is within the notification period, the membership will draft for another month and the buy out fee and cancellation date will be considered terminated 30-days after such date.

I acknowledge that the buy out rate for my monthly membership is calculated on the unused months of my membership contract beginning on the termination date outlined above. The buy out fee is calculated using the percentage of my contractual unused membership, or unused months, applied against the monthly fee for the remaining unused months of my contract. 

I understand that the membership buy out fee will be charged to my credit card on file with Evolve Studio Northshore in full, and my membership will be deactivated and cancelled within the parameters outlined above. 

 

First Member Name

First Name*

Last Name*
First Member Age Acknowledgment*
First Member Date of Birth*
I certify that I am 18 years of age or older
First Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
First Member Signature*
Second Member Name

First Name*

Last Name*
Second Member Date of Birth*
Second Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Third Member Name

First Name*

Last Name*
Third Member Date of Birth*
Third Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Fourth Member Name

First Name*

Last Name*
Fourth Member Date of Birth*
Fourth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Fifth Member Name

First Name*

Last Name*
Fifth Member Date of Birth*
Fifth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Sixth Member Name

First Name*

Last Name*
Sixth Member Date of Birth*
Sixth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Seventh Member Name

First Name*

Last Name*
Seventh Member Date of Birth*
Seventh Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Eighth Member Name

First Name*

Last Name*
Eighth Member Date of Birth*
Eighth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Ninth Member Name

First Name*

Last Name*
Ninth Member Date of Birth*
Ninth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Tenth Member Name

First Name*

Last Name*
Tenth Member Date of Birth*
Tenth Member Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Membership Type
Contract Type*
1 Month Contract
3 Month Contract
6 Month Contract
12 Month Contract

Months Buying Out *

Percentage of Unused Contract *

Buy Out Fee *

Reason for Cancellation *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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