Alpha Omega Gymnastics Membership Freeze Form

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Freeze Your Account
To Freeze your account, please fill out the form below. If you have any questions, please give us a call at 469-859-9936. We look forward to when you return!

* Indicates required field

Thank you for allowing us to continue serving your family!

Parent's Name *

First

Last

Parent's Email *

Parent's Cell Number *

Child's Name to Freeze *

Class Type *

Child #2 to Freeze *

Class Type *

Child #3 to Freeze *

Class Type *

Child #4 to Freeze *

Class Type *

Reason for Membership Freeze *

Child lost interest Financial Medical reasons Moving out of area Not getting any value from the program Unhappy with Staff Too busy/other activities Other (Please elaborate in comments)

________________________

Date to begin "freeze" on your membership *

Please list the date that you would like to begin your "freeze" (use xx/xx/xxxx format)

Date to reinstate your membership (Must be within 60 days of your "begin freeze" date) *

Please tell us the date (within 60 days or less of your BEGIN FREEZE DATE) that you will begin classes again. You are acknowleding that you understand that the CHARGING OF TUITION WILL AUTOMATICALLY BEGIN ON THE 15TH OF THE MONTH PRIOR TO THE MONTH you CHOOSE FOR REINSTATEMENT and that you ARE GIVING PERMISSION FOR THESE AUTO-CHARGES TO OCCUR BASED ON THE INFORMATION YOU HAVE PROVIDED. Example: If you choose to reinstate the membership in September, your account will begin to be charged on AUGUST 15th for September’s tuition, and every 15th thereafter. (use xx/xx/xxxx format)

________________________

Are you satisfied with the services you received from Alpha Omega Gymnastics? *

Yes No Please call me to discuss

________________________

I understand that the charging of tuition will automatically begin on the 15th of the month prior to the month I choose for reinstatement and that I am giving permission for these auto-charges to occur based on the information I have provided. (Example: If you choose to reinstate the membership in September, your account will begin to be charged on August 15th for September’s tuition, and every 15th thereafter. *

I Agree

I understand that there will be no refunds for membership charges that occur once my account has become unfrozen, based on the information that I have provided. Furthermore, it is my responsibility to contact AOG during the time period that there is a freeze hold on my account, if I choose not to re-enroll for classes in order to avoid automatic start of tuition charges for the dates I have designated above. *

I Agree

I also understand and agree that I am responsible for increase of tuition that might have occurred during my absence for my child(ren), should I choose to return to classes. *

I Agree

Should I dispute a charge through my financial institution this will constitute a breach of contract possibly resulting in, but not limited to, penalties, additional fees, collection, legal action, and/or termination of any and/or all current and past agreements. *

I Agree

I request a suspension of my child’s membership for 2 months (a “freeze”). If today is the 9th of the month or earlier, the freeze will go into effect on the 1st day of next month. If today is after the 9th of the month, the freeze will go into effect on the 1st day of the month after next. I understand and agree my child’s membership will resume on the 1st day of the month after the freeze expires. My monthly charges will resume in the month the freeze expires with a charge on the 15th of each month for the following month. I also understand and agree that I am responsible for re-enrolling my child(ren) in classes. (Here is an example of how this freeze works, if a member requests a freeze on May 9th no drafts/charges will occur in May and June and the child’s gym membership will be suspended during the months of June and July. On July 15th the account will be drafted/charged for August’s payment obligation. The member will need to contact the gym to enroll for classes in August.) *

I Agree

I have read all of the information on the Alpha Omega Membership Freeze form and I agree to abide by all of its terms. *

I Agree

Parent's typed name (acting as my signature) *

Today's Date *

Please use date format xx/xx/xxxx