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 Day

Child's Class Time

Reason for dropping Class *

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

Drop Date *

Withdrawal Policy *

I understand that once this document is submitted to the Power in Motion Office your class withdrawal goes into effect on the date in the box above. If you drop a class mid month you will not receive credits and/ or refunds for the remaining classes in the current month.

Signature *

Clear