Freezing Membership Form

I would like to *
Student's Name *
Student's Name
Parent/Guardian name (if applicable)
Parent/Guardian name (if applicable)
Reason for freezing?
Acknowledgement *
Pricing *
Student's last day of class, if more than 30 days away, will be
Student's last day of class, if more than 30 days away, will be
Date of return will be (if applicable)
Date of return will be (if applicable)