Student Hold Request Form

Student Name*
First Last
Parent Name*
First Last
Phone*
Reason for hold*
Please be specific
Continue to run costume payments?*
- Yes
- No
- N/A
Lesson Day*
Lesson Time*
Type of Lesson*
Teacher*
Name
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*
Name
This field is for validation purposes and should be left unchanged.