Name: The Modern Music Academy
Price range: $$

Lessons Withdrawal Form

To discontinue lessons and to discontinue charges to your account, fill out this withdrawal form on or before the 14th of your last month. We do not prorate tuition for the last month’s lessons. As a reminder, per your registration agreement, students will be responsible for their last month’s tuition whether or not they attend lessons. No refunds are given for students missing their last month. No exceptions will be made for moving, relocating, illness, etc.*

Student Name(Required)

First Last

Email(Required)

Phone(Required)

Today's Date(Required)

Last Day Student Will Attend Lesson(Required)

Teacher's Name(Required)

Reason For Withdrawing(Required)