Cancellation request form

First Name *

Last Name *

Phone Number *

Email Address *

Child/ Children allocated to membership *

Cancelation type: *

Boorn membership Education classes NDIS Other

I have used our child's Birthday Party *

Yes (When) NoUnsure

If Applicable; What Date was your Party/s?

Would you like to speak with a supervisor regarding your cancellation? *

YesNo

Feedback or Comment *

I acknowledge, The following points

Cancellation will only be accepted via this form and not by phone or email. *

Date of this submission is the start of the required 4 weeks’ notice period. *

There is a $30 cancellation fee ( reduced from $50 as we have passed on saving using a new system). Why? Our team like to be paid for their time, this is to cover the administrative costs of processing your account closure, including staff time, system updates, and communication with your local center. This is charged on exit rather than increasing the monthly membership cost.

If there are outstanding fees, additional charges will apply as outlined in our terms and conditions. These charges may be automatically deducted from your account.

A $50 monthly fee will be charged until all outstanding amounts are paid in full.

*

Any money owing that may be outstanding or still owing for services will need to be upfront or current financial agreement to continue until all payments have been made. *

During the 4-week period, you may or not be able to continue services offered by BOORN. *

All sessions and visits are correct. *

Any Funds owing to you may be returned to your card or a request to complete a direct bank transfer. *

I have no concerns, complaint or reports to submit, We are leaving in good faith and genuine reasons. *

I may be contacted by management for further exit questions. *

By signing I acknowledge that this is my request to cancel my Membership and BOORN will confirm acceptance of the cancellation request. *

For security please complete the check below *

Signature

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