Change of MembershipForm Name * First Name Last Name Email * Please change my membership to the following: Bronze Silver Gold I give Breathe Pole Dance Academy permission to change membership to the above selection. By submitting this form you are entering a contract for Term 1, 2025 (first week direct debit or full payment will be debited from your account on the 6th January, 2025) * Yes PLEASE READ AND AGREE TO THE FOLLOWING * Breathe Pole Dance Academy Direct Debit Arrangements Agreement 1. This Agreement is subject to change. All changes will be displayed in studio for a minimum of 2 months as per the New Rules for Fitness Services: The Fair Trading (Code of Practice - Fitness Industry) Regulation 2003 2. Direct Debit Arrangements for Courses are available at anytime, please let us know if your circumstances change 3. A deposit (your first weeks payment) is required at time of booking for all new students. 4. Direct debit sign ups after Week 1 require a deposit at time of enrolment. Debits will commence the following Monday as per the usual schedule. (For week 1 catch ups, please refer to ‘Missed Classes and Catch up Policy on our website for more details). 5. Any applicable discount/offer at the time of your enrolment will be applied to your account as per the discount/offer terms and conditions 6. If you have not enrolled for a pole course but would like to attend the casual classes, your direct debit amount remains the same, however this means that you forfeit the course for the current term and cannot be transferred or credited to any other term. 7. Direct debits can be cancelled at anytime, please see our cancellation form for terms and conditions 8. Your Direct Debit Arrangement will stay in place unless terminated by the customer via our cancellation form or Breathe Pole Dance Academy 9. All payments are debited weekly, on the Monday of each week of term. If the Monday falls on a Public Holiday, the payment will be taken on the following business day. 10. The following procedure will be undertaken for any payments which decline: 10.1. The debit amount will be processed the next business day. As a courtesy to the customer we will attempt to send an email or text message notifying the customer that their debit was dishonoured and that it will be retried the following business day. This is a courtesy and may not always happen. It is your responsibility to ensure that you have sufficient funds and that your bank is not blocking the payment. 10.2. An $14.90 dishonour fee is charged. This is charged by Ezidebit and is out of our control. 10.3. The customer is unable to attend classes until the outstanding fees have been brought up to date, as per studio rules. 10.4. Customers who have more than three consecutive dishonoured payments within a term will have their memberships automatically cancelled by Breathe Pole Dance Academy 10.5 All classes are to be booked prior to 3pm the day of your chosen class. If you have paid is full for this service, you are paying for the entire term, the same terms and conditions apply regarding the 10 week contract. Once the term has commenced we will be unable to offer a refund. I declare I have read and fully understand the Direct Debit Agreement (including the pay in full clause, the 10 week no-lock in contract and the casual class fees above) and hereby acknowledge this by clicking the confirmation of contract below: Confirmation of Contract/I agree You have submitted your membership change for next term starting 6 January 2025Let’s get ready to smash some goals :)