Withdrawal Form
Must be received no later than 15th of the month prior to withdrawal. 

Example:
A Cancellation received on February 15th - Withdrawal will be effective March 1st.
A Cancellation received after February 15th - Withdrawal will become effective April 1st.

100 Skyway Drive, San Jose, CA 95111
(408) 513-2450 (OFFICE)     (408) 513-2451(FAX)
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Swimmer First & Last Name *
2nd Swimmer First & Last Name
3rd Swimmer First & Last Name
Parent First & Last Name *
Email *
Effective On *
MM
/
DD
/
YYYY
Reason For Withdrawal *
Required
Further Explanation (Only if other was selected for reason above)
*
Required
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