Student Hold Request Form Student Name* First Last Parent Name* First Last Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Reason for hold*Please be specificContinue to run costume payments?* Yes No N/A Lesson Day* Lesson Time* Type of Lesson* Teacher* First Last Start date to hold lessons* MM slash DD slash YYYY Projected date lessons will resume* MM slash DD slash YYYY New tuition during hold* Original tuition* Hold Policy* I understand I will be charged now for our returning month's tuition in order to hold their spot in class. We will not be charged the returning month's tuition. Tuition will resume the month following our return. I agree to notify the office prior to my student returning to class to ensure he/she is back on the roll.Signature* PhoneThis field is for validation purposes and should be left unchanged.