WITHDRAWAL REQUEST

Please fill out the following form to complete your student's withdrawal from their dance class(es). If they are in more than one class, please list each class you would like to withdraw from. If you are withdrawing more than one student, please complete a separate submission for each student.

Our business office will process your withdrawal request and send you a confirmation of the processed withdrawal. Please allow at least 72 hours for us to process the request.

Parent/Guardian Name

Parent/Guardian eMail

Phone Numer

Student's Name

Student's Teacher Name

Student's Class(es) to withdraw from

Requested Withdrawal Date

Last Day to attend class

Reason for withdrawal

Please check the following boxes indicating your knowledge of the following policies:

I understand that Duet Dance Academy requires written notice to withdraw from a class and that notice must be given by using our online withdrawal request form or by completing a withdrawal form at our front desk.

I understand that there is a $50 withdrawal fee. This fee will be charged to my payment method on file.

I understand that there are no refunds on any fees previously paid when withdrawing from Duet Dance Academy.

I understand that my child's spot in class is no longer held once I withdraw.

I understand that I will be charged the $135 Recital Fee if I withdraw from classes after December 31.

Signature (type name)

Your withdrawal request has been submitted. Our business office will confirm once processed.