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Change Form

Date: March 24, 2023

First Customers Name

First Name*

Last Name*

Phone*
First Customers Date of Birth*
First Customers Signature*
Second Customers Name

First Name*

Last Name*
Second Customers Date of Birth*
Third Customers Name

First Name*

Last Name*
Third Customers Date of Birth*
Fourth Customers Name

First Name*

Last Name*
Fourth Customers Date of Birth*
Fifth Customers Name

First Name*

Last Name*
Fifth Customers Date of Birth*
Sixth Customers Name

First Name*

Last Name*
Sixth Customers Date of Birth*
Seventh Customers Name

First Name*

Last Name*
Seventh Customers Date of Birth*
Eighth Customers Name

First Name*

Last Name*
Eighth Customers Date of Birth*
Ninth Customers Name

First Name*

Last Name*
Ninth Customers Date of Birth*
Tenth Customers Name

First Name*

Last Name*
Tenth Customers Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
CHANGE FORM: Upgrades, Downgrades, Freezing or Cancelling Services - all profile changes will begin the SAME day of submission!
I would like to:*
Freeze
Cancel
Change (upgrade, downgrade or unfreeze EFT)

FOR CANCELLATION CLIENTS: Please understand if you do NOT return your key fob within 5 business days from the day you submit this form, you are agreeing to pay the $15.99 non-returned key fob fee with the card we have on file.






Cancellation Start Date (same day of waiver submission) :

Reason for Cancellation:

FOR FREEZE CLIENTS: Please understand that you are only able to unfreeze your account twice within the current year before a $19.99 fee is applied. ALL FROZEN ACCOUNTS REMAIN IN OUR SYSTEM FOR ONLY 2 YEARS BEFORE ACCOUNT DELETION!









Freeze Start Date (same day of waiver submission) :

Reason for Freezing:

FOR CHANGE CLIENTS: Please understand that if you are unfreezing for the 2nd time within the year, you will be charged a fee of $19.99. 





Payment Due Date:

New Payment Amount:

Notes For Staff:
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*

Phone*
Parent or Guardian's Date of Birth*
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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