Membership Cancellation Request Form

Select your BKs Gym and Swim location

Parents First Name

Parents Last Name

Student First Name

Student Last Name

Mobile

Billing Reference

Reason for wishing to leave BKs Gym and Swim

How would you rate your experience overall with our facility? (1 = Lowest Score 5 = Highest)

What can we improve on? Any other comments? (Optional)

Staff Name

Terms and Conditions

I Agree to the Terms and Conditions

Membership Cancellation Terms and Conditions:

I, the undersigned do hereby request that my direct debit membership be cancelled. I understand that a 14 day notice period is required for all cancellation requests. I understand that my 14 day notice period will be deducted in total from my specific account on my next due debit date. I understand that my membership cannot be cancelled while my account is in default and I must pay all monies owing before cancellation can take effect.