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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