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2. Primary Member Information
4. Last Name*
5. First Name*
7. Primary Phone Number*
8. Secondary Phone Number
10. Email Address*
12. Address *
14. City*
15. State*
16. Zip*
18. Cancellation Request
20. At least a 15-day notice is required to cancel any membership at the CRC. Monthly memberships require a 15-day notice prior to the scheduled draft date (either the 1st or 15th of the month). Members agree to this policy at the time of enrollment when the authorization is given to automatically withdraw monthly fees from their bank account. If we do not receive a cancellation request at least 15 days prior to the member's next draft date, the account will be drafted for the full amount and there will be no refunds. If the draft is rejected or does not go through, the member is still responsible for this balance.
22. When would you like your cancellation to be effective?*

    1. Please Cancel my membership at the next available date according to my scheduled draft.
    2. I would like to delay my cancellation to a specific date listed below.
24. Specific date for cancellation request
    Specific date for cancellation request
26. Membership Type (Check all that apply)*

    1. Adult
    2. Family
    3. Youth/Teen
    4. Special Hours

    1. Special Hours Couple
    2. Adult Plus*
    3. Splash Aquatics*
28. *List each Adult Plus or Splash Aquatics member under your account.
30. Reason for cancellation? *
    -- Select One --Don't use facilityRelocationToo expensiveWork/schoolMedical reasonsDispleased with serviceFacility cleanlinessJoined another facilityBought own equipmentPoor quality instructionCOVID-19Other (explain below)
32. If you selected other, please explain in the space below.
34. Is there anything we could have done to serve you better?
36. Please type name to sign.*
38. Please include date and time
    Please include date and time

    Please include date and time
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field