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:

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:

Reason(s) for withdrawal*

*Reason(s) for withdrawal. Please select all applicable options:

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?

Would you recommend us to your friends?*

*Would you recommend us to your friends?

I understand that no refunds will be issued and my deposit will be used to offset the last month of lesson (where applicable)*