Solina Dance Withdrawal Form
Student Full Name
*
First Name
Last Name
Parent’s Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
May we ask why you wish to withdraw from our program?
**Reason for Withdrawal**
Scheduling conflict
Financial reasons
Found a different activity /program
Lack of interest
Moving or relocating
Other
** Program Experience ** - How would you rate your overall experience at SOLINA Dance Productions?
Excellent
Good
Average
Poor
** Program Experience ** - How would you rate your overall experience at SOLINA Dance Productions?
Excellent
Good
Average
Poor
- Were there any specific aspects of the program you or your child enjoyed the most?
- Were there any areas you feel could be improved?
Suggestions if any for further improvement:
Will you be willing to recommend us?
Yes
Maybe
No
Signature
Submit
Should be Empty: