Student Name

Lesson Class
—Please choose an option—3D printingArt (Private Lesson)Art (Group Lesson)BassCelloChoirClarinetDanceDouble BassDrumFluteGuitarOboePiano (Private Lesson)Piano Group ClassSaxophoneTheater ClassUkeleleViolaViolinVoice

Lesson Length
—Please choose an option—30 minutes45 minutes60 minutesGroup Class

Who was your instructor ?

How were you enjoying lessons ?

Reason for dropping
—Please choose an option—BudgetCharter School FundingLeft AreaLost InterestNeed a BreakPersonal IssuesSchedule ConflictsSummer BreaksOthers

In a couple of sentences, please explain why you are withdrawing from lessons

How was your teacher ?

What can we improve upon ?

Additional Feedback

Policy Acknowledgment
By clicking below, I am agreeing to abide by all policies outlined in the Opus Music School policies. All withdrawals must be processed before the 15th of your last month of lessons- Forms submitted after the 15th will be processed in the following month and student will be responsible for last month's tuition, whether the student attends lessons or not. When a withdrawal occurs after the 15th of the month, the charge for the next month will still go through. Expiration dates for any credits on the student's account will not be affected by withdrawal; however by submitting the form above, you agree to forfeit your current time slot and acknowledge that your current teacher and/or lesson time may not be available when you return. Returning students will still be subject to registration and membership fees at the time of re-enrollment.

I have read, understand, and agree to abide by these policies.

Parent Name

Email

Phone