【日本橋校】退会届
やむを得ない理由により退会する場合は、スクール受付に退会希望月の前月末までにご提出
ください。（例：６月末退会希望の場合、５月３１日２３：５９送信記録まで）前月末日を過ぎてからの連絡の場合は翌々月末の退会となり、そこまでの授業料が徴収されますのでご注意ください。（月謝のご返
金はできません）



If you have an emergency reason, please submit this document to admin by the end of
the month at 23:59 before withdrawal. (Ex If you want to leave at the end of June, the dead
line will be May 31st at 23:59.) We are not able to accept once it passed, so please be
careful. We need to get it earlier if the end day of month is holiday.

Tsukishima/Kachidoki 月島・勝どき校:
Heisei Bldg. 6F 3-30-3, Tsukishima, Chuo-Ku 104-0054
Phone:03-3532-5220 Fax:03-3532-5220
Nihonbashi 日本橋校: RENOBLE NINGYOCHO. 1F 6-4 Tomizawa-cho, Nihonbashi, Chuo-Ku 103-0006
Phone:03-6231-1766 Fax:03-6231-1766

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Email *
届出年月日　Submitting date *
※こちらのフォームを送信する日にち
MM
/
DD
/
YYYY
退会年月　Leaving date *
※末日退会となります　※If you want to leave at the end of June, the dead line will be May 31st
所属校　Belonging *
参加クラス　Student’s class *
Required
参加日程　Attending date *
Required
生徒氏名　Student's name *
保護者様の名前　Guardian's name *
住所　Address *
電話番号 Phone number *
退会理由　Reason for leaving *
備考　Memo
A copy of your responses will be emailed to the address you provided.
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