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Hold Request Form

Please complete all appropriate fields below. Shaded fields are required.

Name of Home or Host Advisor:
First Name:
Last Name:
Street Address:
City, State/Province:
ZIP/Postal Code, Country:
Phone:
Email:
Effective Dates:	Start Date to End Date

I understand that my hold may last one year (12 months) and that all my trainee benefits cease during this time. My internship hours are updated on my google document online.

I acknowledge that I am current with all Teacher Training Program payments and have a zero or positive balance for studio lessons. Based on the length of time “on hold”, I may be required to purchase and perform a Re-Entrance Evaluation ($80.00 USD).

Once the “on hold” period is completed, I am aware that I will resume the program where I left off. Additionally, I understand that if the cost of any part of the Teacher Training Program or The Pilates Center studio fees should change during my hold I will be required to pay the current pricing.

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Your legal name

Your email address

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Timestamp

Audit

2017-02-07 14:55:46 MDT

Hold Request Form Uploaded by Rachel Taylor Segel - forms@thepilatescenter.com IP 50.194.156.193, 50.194.156.193