Change of Enrolment: Discontinue

Change of Enrolment: Discontinue
Student name

First NameLast Name
Name of person completing this form

First NameLast Name
Email
example@example.com
Contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Tuition/ensemble/group discontinued
Enrolment to cease from

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Reason for discontinue
e.g. conflicting activities, lost interest, moving - feel free to leave feedback!
I wish to withdraw my child/myself from lessons as detailed above. I understand that withdrawals can only be made by the end of week 3 of each term, or at the end of term. If I wish to withdraw after week 3, I will be liable for the total fees for the term.

Submission of this form is equivalent to my signature.
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Should be Empty: