Lesson Withdrawal Form
1. A withdrawal form must be completed and submitted by the 10th day of the current month if a student wishes to discontinue lessons the following month/year. 
2. For students under age 18, a signature of a parent or guardian is required.

More inquiry, please contact:
school@newheartmusic.org
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Email *
Student Name *
Parent/Guardian Name *
Phone Number *
Teacher's Name *
Instrument(s) *
Required
Effective Withdrawal Date *
MM
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DD
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YYYY
Reason For Leaving *
Other comments
Withdrawal Policy

1. Please inform the New Heart Christian School of Music if you wish to withdraw from lessons. A withdrawal form must be completed and submitted by the 10th day of the current month if a student wishes to discontinue lessons the following month/year. Verbal notices will not be accepted. You may obtain the withdrawal form on our website. For students under age 18, a signature of a parent or guardian is required.

2. All monthly tuition payments are non-refundable. Once a withdrawal notice has been received, all remaining lessons must be completed by the end of the last paid month.

3. If you decide to withdraw from lessons and re-register at a later time, the $50 registration fee will be applied again.

Acknowledgement *
Parent's Name & Contact number
 *
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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