Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Student Name

First Name

Last Name

Student Name #2 (if applicable)

First Name

Last Name

Student Name #3 (if applicable)

First Name

Last Name

Review of Original Signed Policy Information

LESSON CANCELLATION If at any point you would like to discontinue lessons, a complete month 30-day notice is required. A cancellation notice must be completed via the website and is acknowledged by the studio on the date that it is submitted through the website form. The client must give notice on or before the 1st day of the month for cancellation to take effect that month. If notice is given after the 1st day of the month, the cancellation will take effect at the end of the next following month. Ex: if notice is given on August 10, cancellation will take effect on September 30. If the 30-day notice is not honored, the client will be charged for the final month with the credit card on file. LESSONS ARE YEAR-ROUND, INCLUDING SUMMER. LESSONS CANNOT BE PLACED ON HOLD. If you choose to give up your time slot, it will be offered to a student on the waiting list.

My cancellation requests follows the original signed policy stated above.

Yes

How much longer do you prefer to take lessons?

We would prefer to be done effective immediately.

We would prefer to continue lessons through the time they are paid for.

Reason for stopping lessons:

Cancellation Notice

We were thankful to have you as a part of the studio and your family is welcome back anytime!

Thanks so much!