Change Request 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 would you like this change to take place?
*
Effective immediately
At the beginning of the next semester
Other (please explain below
Change Request
*
Please describe the change you would like in your lesson day or time.
Please acknowledge the following statement:
*
I understand that any possible changes will be made on a rolling basis and are subject to availability
Submit
Should be Empty: