Withdrawal Form

Withdrawal Form

Fill out the form to provide a 2-week written notice of intent to stop music lessons. Complete 1 form per student. Once we receive this notice, the notice begins the following week.
Today's Date*

MonthDayYear
Date: The Two-Week Notice begins the following week of today's date.
Student Name *

First NameLast Name
Parent Name *

First NameLast Name
Parent E-mail*
Parent Cell Phone Number*

Area CodePhone Number
Instructor *
Please select students instructor(s). Multiple instructors can be selected.
Student's Lesson Day *

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Lesson Type Currently Enrolled*
Indicate reason for cancellation*
Other reason for cancellation of lessons:
Please indicate if you will be attending lessons during the 2-week notice.*

Student WILL attend both weeks of the 2- week notice.Student Will NOT attend lessons during the 2-week notice.Student will attend only week 1 of the 2-week notice.Student will attend only week 2 of the 2-week notice.Student will attend ALL LESSONS until last lesson date indicated below. (For students giving notice MORE than 2-weeks prior to final lesson date.)
For Students Giving Notice MORE THAN 2-Weeks Prior:

If you are giving a notice more than 2-weeks prior to your intended stop date, please indicate the date of your last lesson below.
Last Lesson Date

MonthDayYear
Please select the last lesson date student will be attending. To enter a date click on the calendar image to select the last lesson date OR enter the last lesson date by using the format provided in the box: mm-dd-yyyy.
Withdrawal Notice Policy of Music Quarters:
- A 2-week written notice is required to stop lessons.
- The notice begins the following week after the notice is submitted.
- These 2 lessons must be paid regardless of attendance.
- Any pending makeups cannot be used in place of the 2-week paid notice.
- If either of the 2 lessons are cancelled during the 2-week notice, these are not eligible for makeups (if the instructor offers makeups.)
- Any pending makeups cannot be extended past the official stop date. Makeups are not kept on account once the student withdraws from lessons.
- As a reminder, makeups are not required or guaranteed by the instructors, therefore, any pending makeups may not be completed prior to your stop date. Credits are not issued for makeup lessons not completed.
Should be Empty: