MDC Withdrawal Form

Which program are you withdrawing from?

Dancer’s Name

First NameLast Name

Parent/Guardian On Contract

First NameLast Name

Parent/Guardian Email

example@example.com

Today’s Date

Date

Per our contact and studio policy, we require a 3 day notice and tuition UP TO CURRENT must be paid to close your account. This means that tuition up to the date of completing this form must be paid.

By Signing below you agree that you have made all payments up to current and understand that the withdrawal and cancellation of contract will go into effect 4 weeks from today’s date upon receiving your withdrawal fee.

Reason for withdrawal:

We are always looking to improve our programs and facility. How could we have made your experience better?

My Products

Withdrawal

Enter description

$50.00 Quantity

Additional fee to withdrawal from competition to accommodate for extra rehearsals for re-blocking

By selecting to withdrawal from competition, I agree to have all fees paid up to current. I also agree to leave my dancer’s costume at the studio until the end of season.

$175.00

Total

Credit Card