Go No Sen Karate Membership Freeze Form

Go No Sen Karate Membership Freeze Form
We here at Go No Sen Karate understand that at some point in time students request to "FREEZE" their membership for vacations, going out of the country, other activities and/or loss of interest. Although we try to keep everyone on a consistent training routine, especially children, we offer an easy and convenient way to do so. Freezing membership will keep your space at your current payment level without increases. However, in order to keep our Month to Month membership intact, we require 30 days notice to do so. Please understand that although there is no freeze fees incured by you, we absord our billing companies fees as a courtesy to you. Please fill out form entirely and keep for your records. Any and all questions can be answered before completion. Thank you!
Students Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Today's Date *

MonthDayYear
Date
How many months would you like to freeze?*

12
Why would you like to freeze?

Going out of countryVacations with familyMedical challengesOther sportsScheduling issuesTransportation issuesChild Care ChallegesSchool Grades sufferingBehavior "Consequence"Lost interestOther
I understand that I am giving the proper 30 day's notice to qualify for a freeze*

YesNo
I understand that if I am NOT giving the proper 30 day's notice to qualify for a freeze any funds that were or will be drafted can either be used for future lessons or credits to any other event or activity at Go No Sen Karate (Excluding Promotional exams)*

YesNo
Freeze payment date: Please remember must be 30 days from now*

MonthDayYear
Date
Restart payment date:*

MonthDayYear
Date
I understand that my membership will automatically unfreeze on the date I entered to restart membership and if I don't notify Go No Sen Karate otherwise, any funds paid are forfeited.*

YesNo
I understand that if I wish to resume my membership earlier then the expiry of the freeze, I must notify Go No Sen Karate so my account can be unfrozen and payments can restart.*

YesNo
I understand that I can still register for special events (ie. Parent's Night Out, Day Camp, Summer Camp, Seminars, Guest instructors etc.) while my account is frozen.*

YesNo
Member Signature (Parent if student is minor)

Clear
Should be Empty: