Age Group Water Polo Withdrawal

DACA
1080 S. De Anza Blvd.
San Jose, CA 95129
(408) 253-7946 (office)
(408) 253-6443 (fax)

Age Group Year Round Water Polo & Water Polo Plus Program: Must be received no later than the 21st of the month prior to first day of the month you intend to stop participating.
High School Sessional Program: Withdrawals become effective the week following receipt of notification. Refunds and/or account credits are calculated according to the effective date.
Player (1):
Player (2):
Player (3):
Parent/Guardian's Name:
Parent/Guardian's Email Id:
Effective: The first day of:
Example Time Table: A Cancellation received before February 21st - Withdrawal will be effective March 1st.
A Cancellation received after February 21st - Withdrawal will become effective April 1st.
Reason for Withdrawal: Scheduling Conflict
Moving
Medical
Other
Age-Group Year Round Only Medical Withdrawal: Short Term (will return with doctor's release - hold membership)
Long Term (unsure of return - cancel membership)

Short term medical withdrawals (a maximum of two months) are treated as a leave of absence and a doctor's note is required. Though your child's space will be held, your account remains active. You will continue to receive email updates.

I understand that my withdrawal must be received by the 21st of the month prior to the first day of the month I intend to stop participating. 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 registration 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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