Withdrawal Form

WITHDRAWAL FORM
To discontinue lessons and to discontinue charges to your account, fill out and submit this withdrawal form BEFORE THE 15th OF YOUR LAST MONTH.

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 refunds are given for students missing any lessons.

No exceptions will be made for moving, relocating, illness, etc.

I have been made aware and agree that I must fill out this form by the 15th of my last month to have my charges at Jefferson City Music Academy discontinued.

By signing this form, I agree and understand that lessons are month to month, but I must let the Academy know by the 15th of my last month. No exceptions will be made for me, and no refunds will be given to me for this policy.
Student's Name*

First NameLast Name
Parent Name*

First NameLast Name
Signature*

I am signing to indicate I understand the policy. Clear
WHEN YOU ARE WITHDRAWING FROM LESSONS, COMPLETE THE FOLLOWING.
Student's Name
Date of the last lesson you will attend.

MonthDayYear
Date
Reason for withdrawing
Should be Empty:

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