ºÃÉ«ÏÈÉú
Skip To Main Content
Toggle Main Menu
Toggle Search Form
Search This Site
Go
Freeze Form
Freeze Form
Freeze Form
Step
1
of
4
25%
Freeze Form
This electronic version of a freeze form must be submitted 5 business days prior to the month in which you want to freeze your membership. Please refer to our freeze policies for more information. Please allow 2 weeks to receive an e-mail confirmation.
Main Member Name
*
First
Last
Member ID #
*
Number on your Key Tag or Moraine ID
Email Address
*
Phone
*
Payroll Deduction?
*
Yes
No
Do you currently have a locker rental?
*
Yes
No
Are you the only member on the account being frozen?
*
Yes
No
Please note, if you are the main member, all sub-members will be frozen as well. If you are not the main member, please list all additional members to freeze on the next page.
Additional Freezes
Please list all other members of the household in which you would like to freeze.
#1 - Member ID
#1 - Name
First
Last
Please freeze the following for Member #1:
Membership
KidRec Add-On
Highlight all that apply
#2 - Member ID
#2 - Name
First
Last
Please freeze the following for Member #2:
Membership
KidRec Add-On
Highlight all that apply
#3 - Member ID
#3 - Name
First
Last
Please freeze the following for Member #3:
Membership
KidRec Add-On
Highlight all that apply
#4 - Member ID
#4 - Name
First
Last
Please freeze the following for Member #4:
Membership
KidRec Add-On
Highlight all that apply
#5 - Member ID
#5 - Name
First
Last
Please freeze the following for Member #5
Membership
KidRec Add-On
Highlight all that apply
#6 - Member ID
#6 - Name
First
Last
Please freeze the following for Member #6:
Membership
KidRec Add-On
Highlight all that apply
Please list Member ID, name, and services you wish to freeze of any members not listed above.
Freeze Period
PLEASE NOTE THAT FREEZE PERIODS MUST BE AT LEAST 1 MONTH IN LENGTH. MEMBERS ARE ELIGIBLE FOR UP TO 3 FREEZES TOTALING 6 MONTHS IN 1 CALENDAR YEAR. FREEZES CANNOT BE BACK DATED.
Freeze Start Date
*
MM slash DD slash YYYY
Freeze End Date
*
MM slash DD slash YYYY
Freeze Agreement
By initialing next to each line, this indicates you agree with the statement listed. (PLEASE INITIAL BELOW)
I currently have no outstanding balance on my account.
*
I understand that months that are frozen will not count toward my 6 billing cycles to avoid a cancellation fee. I must have 6 active billing cycles to avoid cancellation fees.
*
I understand freeze forms must be submitted at least 5 days before the next billing cycle to avoid charges for the next month.
*
I understand a freeze and the timing of the freeze may be granted in the sole discretion of management.
*
I understand that my spouse and/or dependents memberships will be frozen during my freeze period. They may continue at a higher rate if desired.
*
I understand that my membership will be suspended and I will not have access to the facility during this period.
*
Or a sub member will become the main member if you wish to do so.
I understand that my membership will become active and normal billing will resume at the end of the freeze period.
*
I understand my locker rental will not be suspended when my membership is frozen. I must clean out my locker and submit a locker cancellation form if I do not want to hold my locker.
*
Payroll Deduction Only – I understand that due to payroll processing that my deductions may not end immediately.
Signature
By typing your full name below, you understand the freeze policies and a staff member will contact you if there are any questions regarding your account.
*
