Studio of MoveMINT Withdrawal Form

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Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Dancer Name *

Dancer's Classes To Withdraw: *

Requested Withdrawal Date (A 30 day notice is required for withdrawal) *

Reason For Withdrawal *

Check to acknowledge your understanding: *

I understand my enrollment will cease 30 days after this notification is given and I am responsible for monthly tuition up until that date.

I understand that my dancer's place is not held after withdrawal.

I understand that all previously paid tuition, performance and/or costume fees are non-refundable.

Required

Signature (Type Name) *

Submit

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