WITHDRAWAL FORM

THIS FORM MUST BE RECEIVED BY THE 20TH OF THE MONTH IF YOU WOULD LIKE TO WITHDRAW FROM NEXT MONTH’S CLASSES.

PARENT/ GUARDIAN/ BILLING CONTACT

First Name *

Last Name *

Phone *

Email *

CHILD INFORMATION

Child's Name *

Child's Class *

Child's Class Day *

Child's Class Time

2nd Child's Name

2nd Child's Class

2nd Child's Class Day & Time

3rd Child's Name

3rd Child's Class

3rd Child's Class Day & Time

Reason for dropping Class *

If you want to continue classes til the end of the month please put the 30th/31st .

Drop Date *

Please list any classes (same student or sibling) that you are remaining enrolled in.

Withdrawal Policy *

I understand that this withdraw form must be submitted by the 20th of the month and if not, I will be responsible for the upcoming month’s billing tuition. I confirm that the drop date entered is my last day of active enrollment for the students/classes listed. I also understand that there will be no credits and/or refunds.

Signature *

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