Suspension Request

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SUSPENSION REQUEST
Date*
DD slash MM slash YYYY
Name*
First Last
Email*
Phone*
Suspension Start Date*
DD slash MM slash YYYY
Suspension End Date*
DD slash MM slash YYYY
Reason for Suspension*
Other Reason for Suspension*
Post Body
All medical Suspension required a medical certificate - please present to reception for copying or email your medical certificate to admin@worldgymburpengary.com.au
Consent*
I understand the following:
Please note your Suspension MAY incur fee of $5 weekly instead of your usual weekly fee. This will be confirmed to you in a Confirmation Suspension Email. If you wish to extend this or come back early, please let us know. Please note, if your suspension dates are not aligned with your usual payment dates then an unusual amount of money less than your usual fee may be taken out at the start or the end of these dates. We will also like to remind you that suspended time isn’t taken off from contract length, if you have any questions regarding this, please do not hesitate to get back in touch.
This is your Electronic Signature*
By typing your name and pressing submit you are confirming that the details are true and correct on this form.
First Last
Signature
World Gym Burpengary 159-161 Station Road, Burpengary QLD 4505 T: 07 3053 3170 E: reception@worldgymburpengary www.worldgymburpengary.com.au