Membership Cancellation Form

Student's Name(Required)

First Last

Parent's Name

First Last

Contact Number

Contact Email

Teacher's Name(s)(Required)

Instrument / Class(Required)

Cancellation Reason:(Required)

Describe Teacher(s) Performance:(Required)

What do you like best at Stages Music Arts?(Required)

Do you have any suggestions for improvement at Stages Music Arts?(Required)

Would you like to further discuss your comments with the General Manager?

Yes

No

Is this form being submitted on or after the 16th of the month?(Required)

Yes

No

Which termination option would you like to choose?

Printed Name of Legal Guardian / Adult Student(Required)

First Last