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Please note: A Leave Request will not cancel your membership – rather it provides a break to members and places your lessons on hold. If you wish to depart from the program altogether please ensure that you complete a Departure Request Form.
Member First Name:
Name #1*:
Name #2:
Name #3:
Member Number: (if known)
Member #1 :
Member #2:
Member #3:
Day/s & Time/s of Class/es:
Day #1*:
Class Time #1*:
Day #2:
Class Time #2:
Day #3:
Class Time #3:
Date of First Absence:
Date of Final Absence:

Forms must be submitted by the 25th day of the current month to take effect for the following calendar month where a discounted rate of 30% per session will be charged for lessons during the period of absence. Forms submitted after the 25th day of the current month will not take effect to the month after. A maximum of 6 weeks of leave over a calendar year can be applied per member and leave requests are only applicable for enrolments on Automatic Payment.
I agree to the above Terms and Conditions.

Security code:
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