CHSM Withdrawal/Schedule Change Request
Student First Name
Your answer
Student Last Name
Your answer
Name of Current Instructor
Lesson Type
I would like to adjust my child's enrollment as follows:
Your answer
Reason for change/withdrawal:
Other reason:
Your answer
I understand that if I am requesting a change in day/time/instructor, a $20 administrative fee will be charged to my account.
Please reschedule my child with:
Choose Day (First Choice)
Choose Time (First Choice)
Choose Day (Second Choice)
Choose Time (Second Choice)
Your answer
Name of person completing form:
Your answer
Email address for confirmation
Your answer
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