30-Day Withdrawal Form

Date: _____________

I am requesting to withdraw _________________________________(name) from the following

Bricks class(es): ____________________________________

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Please explain your reason for withdrawing:

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Has this reason been discussed prior to withdrawal with Mandy, the studio owner? Yes OR No

We are here to provide the best possible dance experience for you and your child and anything that prevents that is taken quite seriously. We would like for any situation to be handled quickly and in a positive manner so that your child can continue their experience here at Bricks if circumstances allow.

Please allow Bricks Studio to process your account over a 30-day grace period. This is in order to complete what is necessary in determining a possible refund based on the date of this submitted withdrawal and guidelines set in place for this fall or spring session.

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Parent Name Printed

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Parent Name Signature

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For office use only:

Name of staff member accepting form: _________________________

Date Submitted:_________________________

Mandy’s Signature:___________________________