Withdrawal Form

LOGREA DANCE ACADEMY

Student Name *

Parent Name *

Email

example@example.com

Phone Number *

Street Address *

City, State, Zip *

Indicate which applies: *

Student is submitting withdrawal prior to the start of the session Student is submitting withdrawal after classes are already in session

Indicate the option that best describes your withdrawal *

Student is Withdrawing from Logrea Dance Acacemy (all classes) and will no longer be a registered student at LDA Student is Withdrawing from one or more classes, but will continue with at least one class as an LDA student

Title of Class (please list all classes that student is Withdrawing from and the day(s) the class(es) are held) *

Last date of class attendance (if applicable)

Month Day Year

Reason for Withdrawing *

Email Address *

Comment (if desired)

Once you submit this form, your account will be reconciled and you will be informed of the status of your account (ie. if there is a credit balance, etc.) Withdrawal from classes is not official until you submit this form, and all credits will be calculated from the date this form is received.

WITHDRAWAL FORM