FIT4MOM Chicago - Maternity Leave and Injury Holds
*Maternity leave holds can be processed at the beginning of month of your due date, or as soon as you have the baby, whichever you prefer. Those who choose the beginning of the month for their hold may attend classes for $5 until their due date.
*Fill out this form as soon as possible for injuries to ensure timely processing
*No hold fee applies for Maternity Leave or Injuries
* Required
Email address
*
Your email
Your Name
*
Your answer
Which type of hold are you requesting?
*
Maternity Leave
Injury
If injury hold, please describe the nature of your injury.
Your answer
Due Date and/or Expected Return Date
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of FIT4MOM.
Report Abuse
Forms
