Withdrawal Form (end of next month)
Withdrawal Form
*Required
Parent/Guardian's Full Name
*
*Parent/Guardian's Full Name:
First
Last
Parent/Guardian's Phone Number
*
*Parent/Guardian's Phone Number:
Parent/Guardian's Email
*
*Parent/Guardian's Email:
Student's Full Name
*
*Student's Full Name:
First
Last
Withdrawal Type
*
*Withdrawal Type:
Withdraw from a single enrolled class
Withdraw from all enrolled classes
Single Class Withdrawal Details
If withdrawing from a single enrolled class, please provide Class Name, Day, and Time below:
Date of Final Class
*
*Date of Final Class:
Day
Month
Year
Reason(s) for withdrawal
*
*Reason(s) for withdrawal. Please select all applicable options:
Moving out of area
Unhappy with experience
Dislike teacher
Dislike class
Student lost interest
Changing studios
Scheduling conflict
Other
Please provide more details for your withdrawal reason(s) selected above
*
*Please provide more details for your withdrawal reason(s) selected above:
What can we improve on?
What can we improve on? We value your feedback as we strive to provide the best experience for our students:
Would you consider returning to All That Jazz in the future?
*
*Would you consider returning to All That Jazz in the future?
Please select one
Yes
No
Maybe
Would you recommend us to your friends?
*
*Would you recommend us to your friends?
Please select one
Yes
No
Maybe
I understand that no refunds will be issued and my deposit will be used to offset the last month of lesson (where applicable)
*
Agree
