LESSON BREAK REQUEST FORM

To freeze your membership you must fill out the following form. If we receive your notice on the first day of the month, your membership will be suspended on the last day of the same month. For example, if we receive your notice on May 1, suspension will take effect from May 31. If we receive your notice after the first day of the month, your membership will be suspended on the last day of the following month. This means we will take one more payment before suspending your membership. For example, if we receive your notice on May 10, suspension will take effect from June 30.

Your Name



Your Email

Today's Date:

Break Start Date:

Break End Date:

Studio Location:

Teacher:

Plan:

Reason For Your Break