Wheaton Sport Center

Leave of Absence Application

Date:
Member:
Spouse:
Membership Number:
Home Phone :
Cell/Work Phone :
E-mail:

I wish to suspend my membership beginning on the:
of

I have a medical condition that prevents me from participating in physical activties for at least two months. I have attached my physician's letter of explanation
Extended Vacation (October 1st through April 30th.)

I expect to return to full membership status on:

Leave of Absence Agreement

I understand that should my membership leave of absence be approved, I agree to the following terms (please read the following a type your name. Your typed name will serve as your official signature and agreement.)

The "Leave of Absence Application" Form must be turned in PRIOR to the start date of the leave of absence. No backdating is permitted.

I understand that my Wheaton Sport Center account must be PAID IN FULL prior to the leave of absence.

I understand that I must pay a monthly absence fee (currently $18/month).

I understand that I must EITHER:

A. Pay six months in advance, even if the absence is expected to be for fewer months.
B. Be enrolled and active in the Automatic Payment Program.
C. Have prepaid my membership annually.

I understand that NO ONE ON MY MEMBERSHIP MAY USE THE CLUB, even as a guest, while the leave of absence is in effect.

I understand that my leave of absence can be for a period of no less than two months.

Please type your name and date this will serve as your signature and agreement to the above document.

Member Name: Date: