STUDENT’S NAME: ______________________________________________
This form stops the tuition fees (for accounts in good standing) 14 days after the instructor signs the form.
Fill out or Circle the appropriate information regarding your current lesson:
Day: Mon Tu Wed Th Fr
Duration: 30min 45min 60min
Date of discontinuation: _____________
I understand that I am giving a 14 day notice of cancellation from lessons from the date this form is submitted to the instructor. I understand that full payment is required for the 14 day termination period. I am current with my tuition/fee payments and understand that if I withdraw from lessons before any make-up lessons are completed, these lessons are forfeited. There are no refunds for missed lessons. There are no refunds for missed make-up lessons.
I understand that if I choose to return to the studio, I will be paying the current lesson rate, not the rate I paid at the time of discontinuation.
Parent’s Signature: _________________________________________________
Instructor’s Signature: ________________________________________