JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Membership Change Request
Requests to make changes to a current membership, including cancellations, holds, end date changes, etc.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Who are you filling this form out for?
*
Self
Member of Household
Staff filling out for member
Required
Names
*
Please list full names of all members you are requesting to cancel or hold
Your answer
Email Address
*
Please enter your email address for follow-up communication
Your answer
Request
*
Requests must be received before the first of the month or be subject to a $10 administrative fee. Coming back after cancellation obligates you to 3 months' minimum again if you sign up for an EFT membership. Holds will be scheduled and confirmed ASAP, but you are still welcome to use the gym until the end of the month unless requested otherwise.
Choose
Cancel Membership
Put Membership on Hold
Other
If "other", what is your request?
Your answer
Cancellation/Hold Reason
*
Choose
Travelling
Moving
Can't Afford
Not Enough Time
Injury
Dissatisfaction
Joining a different gym
Lost interest/community
Other
Anything else we didn't ask? Or willing to expand on your reason?
Your answer
I understand that if I am submitting this form after the 1st of the month, my cancelation or suspension is not guaranteed and I may be charged a $10 administrative fee.
*
$10 admin fee is to account for our costs related to credit card processing and additional staff time for retroactive adjustments.
Choose
Yes.
Also, yes.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Scrapyard Climbing.
Does this form look suspicious?
Report
Forms
