Withdrawal Form

To cancel your membership and withdraw from lessons, please submit this form. You will receive an email confirmation once the form has been seen and membership has been cancelled. Once the completed form is received, membership will cease at the end of the current month. Though not required, we appreciate a 3 weeks’ notice for withdrawals.

Parent Name

First Name

Last Name

Student Name

*Individual form must be filled out for each student withdrawal.

First Name

Last Name

Teacher Name

Reason for Withdrawal

Is there a possibility you might return to lessons at a later date?

Yes

I understand that my subscription to Gardner Piano Studio Membership will cease at the end of the current month.

I understand that my subscription fee will not be reimbursed once it is withdrawn on the first of the month. Students may choose to attend remaining lessons or forgo them once this form is submitted.

We welcome your suggestions to make Gardner Piano Studio a better place: