Discontinue Lessons Form
Student Full Name
*
First Name
Last Name
Parent/Caregiver Name (if applicable)
First Name
Last Name
Instructor Name
*
Current Day of Lessons
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please provide the day of your regularly scheduled lessons
Current Time of Lessons
*
Please provide the time of your regularly scheduled lessons Minutes
AM
PM
AM/PM Option
Email - Please list Parent/Guardian if student is under 18 years
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
When will your lessons end?
*
Effective immediately
At the end of the current semester
Other (please explain below)
Reason for Discontinuing Lessons/Comments
*
Please let us know the reason that the student is discontinuing lessons.
Submit
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