Leave of Absence

SUN CITY SUMMERLIN DANCE COMPANY

NOTIFICATION OF LEAVE OF ABSENCE

This form is to be completed by the Sun City Dance Company member requesting to be on a Leave of Absence for medical reasons (member or member’s immediate family) The maximum medical leave of absence is 6 months.

I agree that while on medical leave I am not eligible to be on the floor of all Sun City Dance Company classes.
This form is to confirm that I (the undersigned), a member in good standing with the Sun City Dance Company, will be on a Medical Leave of Absence status:

FROM: Date (Month & year) TO: Date (Month & Year

Reason for the leave:

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Name of class

Name of teacher

Association Number

Signature

If you require an extension of the period stated above, another form must be sent to the Sun City Dance Company. You may be asked for clarification and/or additional information regarding this request.