Withdrawal Request

Respondant

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First name *

Last name *

Email *

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Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Participant

First name *

Last name *

Name of program you wish to be removed from: *

Date & Time of Program *

Reason for withdrawal *

Scheduling Conflict Injury Moving Other x Clear

If other, please explain:

I understand that I will be charged a $25 (plus GST) withdrawal fee and my withdrawal will be processed following the guidelines set out in the Vancouver Circus School Class Policies found HERE.

I have read and accept *

Please note that all withdrawal requests take effect on the date they are submitted. Once this form is submitted, the student’s enrollment ends, and classes may no longer be attended.

I agree *

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Please accept all conditions.

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