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This Temporary Membership Break Request is for the End of the Month and MUST BE RECEIVED BY THE 15th OF THE SAME MONTH. YOU MUST CLICK ON "ALREADY A CUSTOMER..." to log into you customer portal to make sure that this request registers in your child's account. All Temporary Membership Break Requests must be confirmed!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Aunt/Uncle
Brother
Father
Grandparent
Guardian
Mother
Nanny
Other
Owner/Director
Parent
Sister
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Allow child photo Yes/NO:
*
Notes :
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Allow child photo Yes/NO:
*
Notes :
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Allow child photo Yes/NO:
*
Notes :
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Allow child photo Yes/NO:
*
Notes :
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Allow child photo Yes/NO:
*
Notes :
Questions/Options:
Today's Date
*
Child's Current Class, Day & Time
*
Reason for Temporary Break
*
Requested Return Date
*
I would like to return to the same class upon return.
Yes
No
If not the same class, what is the desired Class, Day & Time you would like your child to return to?
If siblings for a temporary break, would you start one sibling at a time when returning?
Your Name
*
Best phone number to reach you
*
Special Request/Notes
Additional Information:
Membership Duration
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I understand that students must have been a member for at least 3 full consecutive months by the termination date.
I've read the above and agree.
Credits or Refunds
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I understand that there are No Refunds or credits for early termination requests.
I've read the above and agree.
Temporary Membership Break Date
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I understand that this Temporary Membership request is for the end of the month and must be received no later than the 15th of the month, which is a minimum of the 2 weeks prior the requested end of month termination date in order to be accepted.
I've read the above and agree.
Temporary Membership Break Status
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Temporary Membership Break requests must not exceed 6 month.
While on Temporary Membership Break, monthly tuition will not be charged and students will not be allowed to attend class.
Temporary Membership Break will be placed on a Student waiting list for the requested class and return date.
Students on Temporary Membership Break are not considered active members and are not eligible for any Member Benefits or Discounts.
I've read the above and agree.
Return to Class
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Return to requested classes is not guaranteed and is subject to availability.
At Return date, no registration is required.
Membership agreement and monthly tuition charges will resume with the current tuition, not passed tuition rates.
Intermediate and advanced students breaking for more than 3 month must be evaluated before returning to an intermediate or advanced class.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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