Whistler Gymnastics - Application for Medical Refund

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Application for Medical Refund:

(Refunds are prorated to the latter date of written notification(including medical) or actual program withdrawal

Name of Gymnast *

Name of Gymnast

Program registered

Program registered

Program Cost *

Reason For Training Absence

Reason For Training Absence

Length of Absence from training *

Length of Absence from training

Date withdrawn from Training

×

Date returned (leave blank if unknown)

×

Please attach medical documentation to support the above request and dates.

Applicant

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile

Signature of Applicant*

Please sign your name inside the box

Type your name

Signature style

Signature of Applicant Signature pad

A required field has not been filled.

Please accept all conditions.

Connect to fill this form

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Email or mobile

Connection code

Waitlist

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Comment

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