Extension Request Form Submission

Pleasanton Mach Martial Arts Extension Request Form

Submission of this request does not automatically mean that extension(s) will be approved/applied.
1. Membership Extensions:

Membership extension requests must be submitted prior to the start of the absence.

• Requests submitted after the absence has begun may not be approved.

• All extension requests must be for a minimum of 4 weeks. Absences shorter than 4 weeks should be managed through make-up classes.

• Annual members may request extensions, provided the absence is 4 weeks or longer.

• If a membership extension is approved, make-up classes are not permitted.

• Members on extension may not attend Level Up Camp and may not be eligible to test if requirements are not completed.

NOTE: You are eligible to make up missed class (see Class Make Ups for further details at Class Make Up Request
Student's Full Name*

First NameLast Name
E-mail*
example@example.com
FremontPleasanton
I am a*
Dates you will be absent (Please enter From and To dates)*
Reason for absence*
Upload File Here

Click to upload
Valid Doctor's Note, or Documentation for Emergency situations. For school holidays, this is not mandatory. Cancelof
I acknowledge that my extension request is 1 week or longer. I acknowledge that IF my extension request is longer than 1 month, my membership rate will no longer be grandfathered in and I will be charged at the going rate of when I resume classes.*

Signature of parent if the student is a minor.
Should be Empty:

Pleasanton Mach Martial Arts Extension Request Form