Notice of Cancellation Form

1
Account Holder Name* This field is required.(Person responsible for tuition payments)
First Name
Last Name
2
Student Name(if different than account holder)
First Name
Last Name
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Email Associated with Scheduling* This field is required.Please use the email associated with your current scheduling and billing notifications. If you are unsure which email to put, please text us at 404.777.4955 or email us at billing@michaelkarlstudio.com
example@example.com
5
Teacher* This field is required.Please select your teacher from the list below.
Please Select
Please Select
Aaron Boudreaux
Aaron Lenhart
Alia Dismuke
Anne Marie Alsobrook
Courtlyn Holt
Desmond Kirkland
Goldie Hatch
Jessie Brownie
Jordan Frazier
Julian Schwarz
Kara Cantrell
Kaylan Royston
Kelsey Pohl
KT Dodd
Madeline Moneypenny
Mateo Rueda-Calvo
Maya Isabella
Michael Karl
Nicole Vazquez
6
Are you wishing to modify or cancel your lesson tuition?* This field is required.
Modify
Cancel
7
Reason for Withdrawal* This field is required.
Financial
Student’s scheduling conflict (e.g., availability changes, new commitments)
Teacher’s scheduling conflict (e.g., inconsistent availability, lesson rescheduling)
Problem with Teacher/Staff
Lost Interest
Teacher was not the right fit for me
Family Emergency
8
Reason for Adjustment* This field is required.
Financial
Student’s scheduling conflict (e.g., availability changes, new commitments)
Teacher’s scheduling conflict (e.g., inconsistent availability, lesson rescheduling)
Family Emergency
9
We totally understand that finances can shift. Would a one-time $50 discount or a lower tuition plan help you stay enrolled?* This field is required.
Yes, I’d like to claim a one-time $50 discount for next month
I’d like to see lower tuition options
No thank you, I’d still like to cancel
10
We’re so sorry to hear that! We want lessons to feel consistent and reliable. Would you like to try switching to a new teacher? You’ll receive a $50 credit to try them out.* This field is required.
Yes, I’d like to try a new teacher and use the $50 credit
No thank you, I’d still like to cancel
11
We know schedules get complicated. Would switching to a different teacher or time help?* This field is required.
Yes, I’d like help finding a time or teacher that fits
No thank you, I’d still like to cancel
12
We want every student to feel supported. Would you be open to trying a different teacher or having someone reach out?* This field is required.
Yes, I’d like to switch teachers and try a free trial lesson
No thank you, I’d still like to cancel
13
Totally fair—sometimes our interests change. But if there’s a way to bring the joy back, we’d love to try! Would you be open to a new teacher, class type, or one free “reignite” lesson?* This field is required.
Yes, I’d like to try a free lesson or switch it up
No thank you, I’d still like to cancel
14
That’s okay—finding the right teacher is a personal process. Would you like help finding someone who’s a better match? You’ll get a $50 credit to try a new teacher.* This field is required.
Yes, I’d like to try a new teacher with the credit
No thank you, I’d still like to cancel
15
We’re thinking of you and your family. Would you like us to place your lessons on hold and keep your credits safe until you’re ready to return?* This field is required.
Yes, please hold my credits until I return
No thank you, I’d still like to cancel
16
I am interested in lessons in the future.* This field is required.
YESNO
17
When do you plan to return?* This field is required.
Date
Month
Day
Year
18
Current Lesson Plan* This field is required.
Please Select
Please Select
Blue 30 (Two 30 minute lessons per month)
Blue 45 (Two 45 minute lessons per month)
Blue 60 (Two 60 minute lessons per month)
Gold 30 (Four 30 minute lessons per month)
Gold 45 (Four 45 minute lessons per month)
Gold 60 (Four 60 minute lessons per month)
19
New Lesson Tuition* This field is required.
Please Select
Please Select
Blue 30 (Two 30 minute lessons per month)
Blue 45 (Two 45 minute lessons per month)
Blue 60 (Two 60 minute lessons per month)
Gold 30 (Four 30 minute lessons per month)
Gold 45 (Four 45 minute lessons per month)
Gold 60 (Four 60 minute lessons per month)
20
I understand and agree to the following:* This field is required.As per our lesson policy, to terminate lessons, written notice must be given by the 15th day of month to change or stop recurring billing for the following month. (ie. if you need to cancel for December lessons, we must have notice by November 15) If notice is given after the 15th day of the month, your account will be charged for the following month of lessons. This online form counts as written notice. Please be aware that all sales are final. This means that we do not offer refunds for any lessons, tuition fees, or classes, including those that are canceled, missed, or purchased in advance. This policy applies to all payment methods, including autopay. If I am taking a break for any period of time, then my preferred teacher and/or time may not be available when I return, and my child (or I) may have to relearn certain concepts and techniques. I will be responsible for paying a $25 re-entry fee upon my return. If I am terminating due to financial reasons or schedule conflict, then I have already discussed possible alternatives with MKPA staff, including possible financial aid. If I am terminating due to a staff or teacher issue, then I have already spoken to management about resolutions and/or other teachers who may be available.
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Final Lesson Date* This field is required.Please be aware that any changes or cancellation requests submitted after the 15th of the month will still be charged for the following month of lessons, as per studio policy. Please indicate the final date the student plans on attending.
Date
Day
Month
Year
22
You've selected to continue lessons with a new option. What happens next:* This field is required.By submitting this form, you are confirming your decision to remain enrolled at MK Performing Arts under the selected adjustment (e.g., discounted rate, new teacher, revised schedule, or temporary hold). This means that your current membership will remain active, and your billing will continue as normal unless otherwise specified. If a discount or credit was selected, it will be applied to your next billing cycle. If you’ve chosen to switch teachers, a member of our team will reach out within 48 hours to coordinate the change and apply any applicable credit. Please note that adjustments like discounts or teacher changes are offered once per student and are not guaranteed to be available again in the future. We’re so glad you’re staying with us, and we look forward to supporting you in your continued training.
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Is there anything we can do to serve you better here at MK Performing Arts?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
24
Additional Comments
Huge
Large
Normal
Small
Ok
Ok
25
Digital Signature* This field is required.I hereby confirm that I have read and understood all statements provided and agree to the terms and conditions as outlined.
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