Loading...

SAXT Auto-payment Suspension Form


Please be informed that you can suspend your auto-payment for a one, two, or three-month duration. SAXT Auto-payment Suspension Form must be completed to hold any Sports Academy Auto-payment. By filling out this form you are agreeing to the Suspensions Terms and Conditions of below.

 

Suspension Terms and Conditions:

  • Auto-payment suspensions cannot be backdated.
  • Payments will automatically recommence after the suspension period has been completed and debit fees will be adjusted as applicable.
  • During the suspension period there will be no privileges available to the client. During the suspension period, if a suspended client participates in services, they will be charged a drop-in rate for services. Participation for suspended client is subject to approval.
  • By suspending your Auto-payment, all reservations during that time period will not be held.
  • Once suspension is lifted, we will do our best to accommodate prior schedule, but cannot guarantee the same schedule held prior to suspension.
  • Requests for suspension must be submitted on an authorized Auto-payment  Suspension Form.
  • Suspensions will only be accepted in writing. Not accepted over the phone or verbally.
  • Suspensions cannot be applied if written notice has been provided cancelling this Auto-payment Agreement.​


Today's date: January 30, 2025


First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

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

Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Suspension Information

Choose your suspension start date. *
Please select the length of your suspension.*
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*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!