Lesson Withdrawal Form

How old is the withdrawing student?

Under 18
Over 18

Parent/Guardian's Name

First Last

Student's Name*

First Last

Phone*

Email*

Reason for Withdrawing*

On a scale of 1 to 5 with 5 being the most positive, how would you rate your teacher? *

Any Suggestions for your teacher or school:

What could we have done differently to keep you as a student?

Terms Acceptance

This is my withdrawal notice as specified on the Paper Moon Music Studio Policy form I signed upon my registration. I understand that the withdrawal notice must be given by the 15th to end lessons at the end of this month and if I submit this form after the 15th, my enrollment and monthly tuition will stop at the end of next month.

I agree to the above.

Music Lessons in San Diego Point Loma area

Offering quality piano, guitar, bass, violin, banjo, ukulele and voice lessons in San Diego, CA.