First name:

Last name:

Student’s first and last name:

Email Address:

Reason for withdrawal:

Will student attend remaining lessons?Yes, student will attend remaining lessonsNo, student will forfeit remaining lessons

Does student plan to resume lessons in the future?Yes, this is just a breakNo, this is a permanent withdrawal

Comments

Acknowledgement of withdrawal policyI understand that notice to withdraw must be received by the reception desk on or before the 15th. Should notice be given after the 15th, the account will be billed for the following month regardless of student attendance