Guardian's Name
*
First Name
Last Name
Student's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Teacher's Name
Instrument
Reason for cancelling lessons
Last date you would like to attend lessons
*
I understand that lessons are billed in advance by the month and that if I stop mid-month, I will not receive a refund or credit for any remaining lessons. I understand that if I request to discontinue lessons and it is the 26th of the month or later, I may have already been charged for next month and am not eligible for a refund.
*
I understand
Signature
*
Submit
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