Student Name *

First Name

Last Name

Parent Name

If requesting on behalf of your child

First Name

Last Name

I acknowledge that my membership will continue through the end of the current billing period for which I am paid. I authorize Parkour Tualatin to charge my credit card that is on record with Parkour Tualatin for any outstanding balances, including early termination fee (if applicable), that remain on my account upon the successful termination of my membership. *

I agree

I understand that this is only a request for cancellation of membership and the cancellation date of my membership will be communicated to me upon the successful review of my membership agreement and account by a membership account representative of Parkour Tualatin. It may take up to 3 business days to review and cancel my membership. *

I agree