EzySwim | Members - Leave Request Form


	Please note: A Leave Request will not cancel your membership – rather it provides a break to members and places your lessons on hold. If you wish to depart from the program altogether please ensure that you complete a Departure Request Form.



	Venue*:


	Surname:*


	Member First Name:

	Name #1*:

	Name #2:

	Name #3:


	Member Number: (if known)

	Member #1 :

	Member #2:

	Member #3:


	E-Mail*:


	Day/s & Time/s of Class/es:

	Day #1*:

	Class Time #1*:



	Day #2:

	Class Time #2:



	Day #3:

	Class Time #3:

Date of First Absence:

Date of Final Absence:

Forms must be submitted by the 15th day of the current month to take effect for the following calendar month where a discounted rate of 30% per session will be charged for lessons during the period of absence. Forms submitted after the 15th day of the current month will not take effect to the month after. A maximum of 6 weeks of leave over a calendar year can be applied per member and leave requests are only applicable for enrolments on Automatic Payment.

	Security code: