withdrawal Form Withdrawal Form - Important Information To discontinue lessons and charges to your account, please notify our Admin Staff and fill out the withdrawal form below before the 15th of your last month. By filling out the form and clicking submit below, you agree to withdraw from Music Box: • We do not prorate tuition for the last month’s lessons. • Students will be responsible for their last month’s tuition whether or not they attend lessons. • No exceptions will be made for moving, relocating, illness, etc. Student Name * Student Withdrawing from Lessons First Name Last Name Parent/Guardian Name Please Provide if Student is Under 19yrs First Name Last Name Email * Last Lesson Write the date of the last lesson you will attend MM DD YYYY Reason for Withdrawal? I am Aware of Charges I have been made aware and agree that I must notify Music Box Admin Staff by the 15th of my last month to have my charges at Music Box discontinued. Yes, I am aware of the charges and have read the 'Important Information' listed above We are sorry to see you go and hope you enjoyed your lessons at Music Box. Our staff will connect with you to confirm that your withdrawal has processed on our end.Wishing you the best during this next season.
