The Mobile Music Teachers LLC policies for withdrawal from lessons are as follows:
Student's Name
Guardian's Name
Home Phone
Cell Phone
Work Phone
Email
Current Address
City, State
Zip Code
Teacher's Name
Instrument Being Taught
Reason for Withdrawing
Comments (Optional)
Compliments (Optional)
Concerns (Optional)
I have read and understand the Withdrawal policies above. I hereby authorize the withdrawal of the student(s) from their lessons with Mobile Music Teachers LLC.
By typing my name below, I authorize the verification of the information provided on this form as correct.
Signature of Student (or Guardian if student is under 18)
Date