WITHDRAWAL FORM .pdf

BAYOU BELLES WITHDRAWAL FORM
As stated in our registration packet, this form must be submitted to Bayou Belles thirty days before the
end of the month to cancel a membership. If this written notification is not received by Bayou Belles by
this date, the account will be charged for the following month. Upon cancellation, participation in
classes at Bayou Belles will end at the end of that month. If a member decides to re-enroll, registration
and monthly fees will be re-assessed. This form may be submitted to Bayou Belles in person or emailed
to bayoubellesspirit@gmail.com.
Participant’s Name: ____________________________________________________________________
Class Day & Time: ______________________________________________________________________
Reason for Withdrawal:
_____________________________________________________________________________________
_____________________________________________________________________________________
Parent Name: _________________________________________________________________________
Signature: ____________________________________________________________________________
Phone Number: _______________________________________________________________________