De Anza Cupertino Aquatics

DACA 1080 S. De Anza Blvd. San Jose, CA 95129 (408) 253-7946 (DACA) (408) 446-5600 (DACA Swim School)	Withdrawal Form (must be received by the 15th of the month prior to the first day of the month you intend to stop swimming)
Student's Name(s):
Parent/Guardian's Name:
Parent/Guardian's Email Id:
Swim Day/Time:	(ex: Wed / 4:00 pm)
Last Swim Date:	(mm/yyyy)
Cancellation Time Table:	Cancellation received before June 15, 2008 - Withdrawal is effective July 1, 2008 Cancellation received before July 15, 2008 - Withdrawal is effective August 1, 2008 Cancellation received before August 15, 2008 - Withdrawal is effective September 1, 2008 Cancellation received before September 15, 2008 - Withdrawal is effective October 1, 2008 Cancellation received before October 15, 2008 - Withdrawal is effective November 1, 2008 (must be received by the 15th of the month prior to the first day of the month you intend to stop swimming)
DACA Program:	Competitive Pre-Competitive Swim School Other
Reason for Withdrawal:	Moving Medical Scheduling Conflict Other
I understand that my withdrawal must be received by the 15th of the month prior to the first day of the month I intend to stop swimming. All cancellations become effective on the first of the month. All withdrawals are final. If I change my mind, I must re-register and I understand that registation is on a space available basis. I understand that my account must be paid in full before the cancellation becomes effective.
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