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Sports Academy

Auto-payment Cancellation Request Form

 



January 30, 2025

Please fill out the following form to begin the auto-payment cancellation process.

Once submitted, our team will be in contact with you within the next 48 hours to complete cancellation.

All terminated auto-payment contracts will be subject to any new rates and start-up fees if client returns to Sports Academy.



Please select the age of the cancelling member...
AdultMinor
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First Cancelling Client Name

First Name*

Last Name*

Phone*
First Cancelling Client Age Acknowledgment*
First Cancelling Client Date of Birth*
I certify that I am 18 years of age or older
First Cancelling Client Reasons
Select the reason for cancelling your membership.*
Unsatisfied with service
Unsatisfied with the facility
Program / Class scheduling conflict
Illness / Injury
Moving out of area
Financial
Other

Please explain the reason for cancelling your membership. *
Please rate your experience with Sports Academy, 5 being excellent.*
1
2
3
4
5
First Cancelling Client Signature*
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*

Relationship*

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 Reasons
Select the reason for cancelling your membership.*
Unsatisfied with service
Unsatisfied with the facility
Program / Class scheduling conflict
Illness / Injury
Moving out of area
Financial
Other

Please explain the reason for cancelling your membership. *
Please rate your experience with Sports Academy, 5 being excellent.*
1
2
3
4
5
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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