Student's Full Name
*
Email
*
Phone
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What's the reason for your cancellation?
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Please select the option below that best describes your reason for leaving
Financial reasons
Moving out of town
Classes are too hard
Injury
Schedule Conflict
Maternity / Paternity
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Is there anything we can do to change your mind?
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How would you rate staff attention to your goals and needs?
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Select one
Great
Ok
Poor
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Overall, how would you rate your experience?
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Select one
Great
Ok
Poor
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How likely are you to recommend our gym to friends/family?
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Select one
Highly likely
Maybe
Not likely
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Please verify
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I understand that my membership will be canceled 30 days from the date this form was submitted.
I understand that if I have a scheduled payment within this 30-day period, the payment will be processed as scheduled. All payments are non-refundable.
I understand that I may be subject to new membership rates if I rejoin the gym at a later stage.
By marking 'yes', I understand that submitting this form doesn't automatically cancel my membership. I also understand that a staff member will reach out to me to follow up, and that my requested cancellation date is subject to our gym's policies and procedures.
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Yes
Request cancelation