Premiere Dance of Flemington Cancellation Form

PLEASE PRINT

Date____________

Student Name______________________________

Class(#, day and time)_____________________________ Instructor_______________________________

Reason for dropping:

____________________________

(PARENT(S)/GUARDIAN(S)  SIGNATURE)

Please give to the front desk before processing.

Note:  If you do not drop before the 10^th of a month, you will be charged for the proceeding month.

Office Use Only

Date Processed________________Staff Initials_______________________

Previous Monthly Fee_____________  New Monthly Fee______________

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