Lesson Discontinuation Form
Thank you for being a part of our community at Amped School of Music! It has been an honor to serve you and we hope to see you again soon! Please fill out this form to submit your request for lesson discontinuation. Please carefully read and understand our lesson discontinuation procedures before digitally signing and submitting this form.
Sign in to Google to save your progress. Learn more
Email *
Student Full Name *
Instrument *
Teacher Name *
Reason for Withdrawal *
Required
I am interested in continuing lessons in the future. *
If you are interested in continuing in the future, when are you thinking of starting up again?
What could we have done to better serve you here at Amped School of Music? *
Additional Comments?
I UNDERSTAND AND AGREE THAT:
If I am taking a break for any period of time, then my preferred teacher and/or time may not be available when I return, and my child (or I) may have to relearn certain concepts and techniques. I may be responsible for paying a registration fee upon my return. If I am terminating due to financial reasons or schedule conflict, then I have already discussed possible alternatives with Amped staff, including possible financial aid. If I am terminating due to a staff or teacher issue, then I have already spoken to management about resolutions and/or other teachers who may be available.
Agreement *
Required
DISCONTINUATION POLICY
IMPORTANT PAYMENT INFORMATION: As per our lesson policy ( www.ampedschoolofmusic.com/lessonpolicy ), to stop lessons, written notice must be given by the 15TH DAY OF THE FINAL MONTH OF LESSONS to stop tuition for the following month. If notice is given after the 15th day of the month, your account will be charged for the following month of lessons. This online form counts as written notice. No refunds, makeups, or credits are given for lessons not attended by the student.
Final Lesson Date *
*IMPORTANT* If this form is filled out after the 15th of the month, your account will still be charged for the following month of lessons, as per policy. Please indicate the final date the student plans on attending.
MM
/
DD
/
YYYY
Digital Signature *
Your full name
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy