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Membership Cancellation Form 

** To Cancel your Level II Membership, you must return this form to our facility 10 DAYS PRIOR to your billing date to avoid next months Billing**


All forms can ONLY be completed by the Membership's Group Leader
I acknowledge that I am the Head Account Holder for this Membership*
Yes
First Member Name
First Name*
Last Name*
Phone*
First Member Age Acknowledgment*
First Member Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Member Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
First Member Signature*
Second Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Third Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Fourth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Fifth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Sixth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Seventh Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Eighth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Ninth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Tenth Member Name
First Name*
Last Name*
Member Date of Birth*
Date of Birth
Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Address *
City *
State *
Zip *
Reason for Cancellation *
Would you consider joining Level II Fitness in the Future?*
Yes
No
Date *
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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