Person Completing Form
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Phone
*
Email
*
Reason for Membership Change
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Child Lost Interest
Financial
Medical Reasons
Moving Out of Area
Not Getting Any Value From the Program
Unhappy With Staff
Too Busy/Other Activities
Other (Please elaborate in the additional comments)
Family Last Name
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Child(ren) Name(s)
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Current Membership Level
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Omega Unlimited Membership
Youth Membership
Alpha Access Membership
Date to End Membership
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Cancel Membership
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Yes
No
I understand that by cancelling my membership I will be required to pay an enrollment fee if I decide to return to Alpha Omega.
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Yes
Are you satisfied with the services you received from Alpha Omega?
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Yes
No
Would you recommend our program to a friend?
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Yes
No
Any additional comments or suggestions you would like to give us?
Cancellation Signature
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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 346-616-1791 or replying STOP to any message.
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