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Change Form

Date: January 24, 2022

First Customers Name

First Name*

Last Name*
First Customers Date of Birth*
I certify that I am 18 years of age or older
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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
CHANGE FORM: Upgrades, Downgrades, Freezing or Cancelling Services - all profile changes will begin the same day of submitting this form.
I would like to:*
Freeze
Cancel
Change

For Cancellations: 


Cancellation Start Date:
FOR CANCELLATIONS ONLY: Please check the box below that you 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. *
I agree
I am ONLY freezing my account and would like to keep my key fob until I unfreeze or renew my package.

Reason:

For Freeze Customers:


Freeze Start date:

Reason:

For Change Package Customers:


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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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