Name of Parent/Guardian *

First Name

Last Name

Phone

(###)

###

####

Withdrawal Policy *

I am confirming my child's withdrawal from the class(es) listed above. I understand that notice of this withdrawal must be done a month in advance and that failing to give notice within that time period will result in my account being charged for the next month. I understand that tuition will not be refunded or prorated for withdrawal. No withdrawals will be accepted after March 31 for the school year.

I agree with the above statement.

Today's Date *

MM

DD

YYYY