Person Completing Form *

Phone *

Email *

Family Last Name *

Child(ren) Name(s) *

Current Membership Level *

Omega Unlimited Membership

Youth Membership

Alpha Access Membership

Date to End Membership *

Cancel Membership *

Yes

I understand that by cancelling my membership I will be required to pay an enrollment fee if I decide to return to Alpha Omega. *

Yes

Are you satisfied with the services you received from Alpha Omega? *

Yes

Would you recommend our program to a friend? *

Yes

Any additional comments or suggestions you would like to give us?

By checking these boxes below, I acknowledge that I have read, understand, and agree to the Alpha Omega Gymnastics & Dance Membership Cancellation Policy and terms below:

If this cancellation request is submitted on or before the 10th day of the month, the cancellation will become effective on the 1st day of the following month.

If this cancellation request is submitted after the 10th day of the month, the cancellation will become effective on the 1st day of the month thereafter.

I understand that my child’s membership benefits and enrollment will end based on the effective cancellation date.

I understand that tuition charges will continue through the applicable cancellation period according to the terms above.

I understand that if my child re-enrolls after an absence of more than 2 months, current tuition rates and re-enrollment fees will apply.

I understand that submitting a charge dispute or chargeback through my financial institution for valid charges may constitute a breach of contract and may result in additional fees, collections activity, legal action, and/or termination of current or future services and agreements with Alpha Omega Gymnastics & Dance.

Example: If a cancellation request is submitted on or before May 10th, no additional tuition will be charged after May, and membership will end June 1st. If a cancellation request is submitted after May 10th, tuition will still process on May 15th, and membership will end July 1st.

Cancellation Signature *

Clear

By providing your phone number, you agree to receive phone calls and text messages from Alpha Omega Gymnastics & Dance regarding programs, events, promotions, account notifications, and other marketing communications. You understand that these communications may be sent using automated technology, pre-recorded messages, or an AI voice assistant. Consent is not a condition of purchase. You may opt out of text messages at any time by replying STOP, and you may opt out of calls or request removal from communications by contacting us at 281-519-2150 or replying STOP to any message.