Withdrawl Request Form

Withdrawal Request Form

Shining Stars Dance Academy at Atlantic Shores
STUDIO WITHDRAWAL POLICY AS STATED IN THE HANDBOOK AND AGREED UPON AT REGISTRATION:
We understand issues arise that may require a student to withdraw from class. The studio must be notified prior to the last day of the previous session to avoid tuition for the next session being due. Please keep in mind that all registration, tuition, costumes, shoes, merchandise, etc. cannot be prorated, refunded or transferred.*
Parents Name*

First NameLast Name
Parents Email*
example@example.com
Best Contact Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students Name*

First NameLast Name
Classes being dropped*
Reason for drop*

Products*

Balance Due On Parent Portal AccountPlease refer to your parent portal account for the amount due.

$ Free

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Comments*
By signing and submitting this form I authorize Shining Stars Dance Academy to process payment on my card above for the amount presently due on my parent portal account plus any future tuition due or costume fees due. I understand SSDA's drop policy listed above and understand it will take 2-4 business days to receive confirmation of the withdrawl request for my dancer a receipt of the transaction will be emailed to me.
Signature*

Clear
Should be Empty:

Withdrawal Request Form