Lesson Discontinuation Form

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Thank you for being a part of our community at Amped School of Music! It has been an honor to serve you and we hope to see you again soon! Please fill out this form to submit your request for lesson discontinuation. Please carefully read and understand our lesson discontinuation procedures before digitally signing and submitting this form.

Email *

Student Full Name *

Instrument *

Choose ALL instruments that you wish to discontinue.

bass

composition

drums

guitar

piano

viola

violin

voice

ukulele

ensemble / rock band

Required

Type of Discontinuation

I am stopping ALL lessons and offerings from Amped

I am stopping ONLY the offerings listed above and will continue other offerings

I am SHORTENING my lessons (i.e. changing hour long lessons to 1/2 hour long lessons)

Clear selection

Teacher Name *

Reason for Withdrawal *

My schedule is too busy

Amped didn't have times that worked for my schedule

Financial

Lost Interest

Family emergency

Moving/Out of Town

Conflict with teacher or staff

Other:

Required

I am interested in continuing lessons in the future. *

Yes

Maybe

If you are interested in continuing in the future, when are you thinking of starting up again?

Any suggestions for us? *

Additional Comments or Feedback

I UNDERSTAND AND AGREE THAT:

If I am taking a break for any period of time, then my preferred teacher and/or time may not be available when I return, and my child (or I) may have to relearn certain concepts and techniques. I may be responsible for paying a registration fee upon my return. If I am terminating due to financial reasons or schedule conflict, then I have already discussed possible alternatives with Amped staff, including possible financial aid. If I am terminating due to a staff or teacher issue, then I have already spoken to management about resolutions and/or other teachers who may be available.

Agreement *

I agree to the statements above and that I must give notice by the 15th of the month to stop autopay for the following month.

Required

DISCONTINUATION POLICY

IMPORTANT PAYMENT INFORMATION: As per our lesson policy ( www.ampedschoolofmusic.com/lessonpolicy ), to stop lessons, written notice must be given by the 15TH DAY OF THE FINAL MONTH OF LESSONS to stop tuition for the following month. If notice is given after the 15th day of the month, your account will be charged for the following month of lessons. This online form counts as written notice. No refunds, makeups, or credits are given for lessons not attended by the student.

Final Lesson Date *

*IMPORTANT* If this form is filled out after the 15th of the month, your account will still be charged for the following month of lessons, as per policy. Please indicate the final date the student plans on attending.

YYYY

Digital Signature *

Your full name

A copy of your responses will be emailed to the address you provided.

Submit

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