MJMS LESSON WITHDRAWAL FORM

We are sorry to see you go! Please complete the form below to discontinue your lessons with MJMS.

Students wishing to discontinue lessons and recurring charges to their account must submit the official MJMS withdrawal form by the 15th day prior to the month in which they wish to discontinue, no exceptions. Payment will be stopped on the first of the month following (eg. if we receive notice on or before March 15th, lesson payment will stop on April 1st).

Please note: Withdrawal notice may not be given to the teacher. Students are responsible for paying lesson tuition for any unused lessons.

Student Name

First Name

Last Name

Instructor Name

Lesson Day

Lesson Time

Date you wish to discontinue lessons

YYYY

Parent Name

First Name

Last Name

Parent Email

Parent Phone

(###)

###

####

Reason for withdrawal

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