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Lesson Withdrawal

I wish to withdraw from lessons at Make Music With Daddyʼs℠. I understand I must withdraw
before the 15th of the month or I will pay one more monthʼs tuition.

Todayʼs Date ______________________________________________

Print Name _______________________________________________

Address _________________________________________________

City _____________________________________________________

State ________________________

Zip __________________________

Make Music With Daddyʼs℠ Location___________________________

Teacher __________________________________________________

Lesson Day & Time _________________________________________

Stop Date/ Last Lesson ______________________________________

Payment Type DEBIT CC PayPal Subscription

Reason for leaving the program____________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Sign Here __________________________________________________________

444 Providence Hwy Dedham, MA 02062 (781) 85-MUSIC makemusicwithdaddysdedham.com makemusicwithdaddys@gmail.com

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