Health Club or Aquatic Membership Cancellation Form

Please fill in the form if you wish to cancel your Health Club or Aquatic membership. Please note, this is not for Swim ARCademy memberships. Please visit here for Swim ARCademy cancellation.

A form must be filled in for every family member who wishes to cancel.

First Name:

Last Name:

Contact Number:

Email Address:

Reason for cancelling:

Cancellation Date

Please specify a date you would like your membership cancelled from (It must be at least 28 days from today)

Please check the boxes to acknowledge all of the following:

From:

My cancellation date is at least 28 days from today's date

I acknowledge that if I am within a 6 month minimum term membership, I will be charged an early exit fee of $49

I understand that my membership type/rate may not be available if I wish to join Cockburn ARC in the future

A suspension cannot be imposed during the 28 day notice period. If you are currently suspended, your membership will be reactivated and the pro-rata will be added to your next direct debit

I understand that any suspension time taken does not form part of a minimum membership term

I understand all outstanding payments must be paid

I acknowledge I have authority to submit this form.

Health Club or Aquatic Membership Cancellation Form

Cancellation Date

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