Illumination Dance Withdrawal Form

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Please submit a separate form for each dancer.

Email *

Student Name *

Withdrawing from the following class(es): Check all that apply. *

Toes & Tumbles

5-7 Combo

7-9 Combo

8 & Up Combo

10 & Up Combo

Combo 3

Combo 4

Combo 5

Acro

Ballet

Hip Hop

STC

Musical Theatre

Required

WITHDRAWAL CONFIRMATION

*I acknowledge that if Illumination Dance receives this form ON OR AFTER THE FIRST DAY OF THE MONTH, I am responsible for that month's tuition. I also acknowledge that if I choose not to finish that month of classes, I will not be refunded for the classes missed.

Parent's Electronic Signature *

Thank you for dancing with US!

We are going to greatly miss dancing and spending time each week with your child! We wish you all the best and hope to see you again in the future!

Send me a copy of my responses.

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