East Valley School of Music

Notice of Withdrawal

EVSM Contract 30-Day Notice of Withdrawal Policy

East Valley School of Music requires a 30-day notice of withdrawal from lessons at any time. To withdraw, please inform your instructor and fill out a Notice of Withdrawal Form to turn in to the front office. If a student is unable to finish out the 30 days, the remaining lessons must be paid for in full.
By signing this form, you are notifying East Valley School of Music of your intent to withdraw
   from lessons.

I, , have reviewed the terms of this agreement and wish to withdraw from lessons at East Valley School of Music.


Reason(s) for Withdrawal:

Date of final lesson:                                    Date final invoice was sent: 

Talked to:                                                                Date: 

Method of Contact:          __In Person      __By Phone      __By Email
Procedures (initial after complete):

___ Notified instructor   ___ Recurring Invoices/Billing
___ Master Database     ___ Instructor Pay
___ Teaching Schedule   ___ Form Scanned
___ Teachworks             ___ Confirmation Email
___ Adjust final invoice  ___ Manager’s Initials

I understand that by signing below I am withdrawing, from lessons at East Valley School of Music in accordance with EVSM Withdraw Policy outlined in the Client Contract signed upon enrollment. 

Leave this empty:

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Signature Certificate
Document name: Notice of Withdrawal
lock iconUnique Document ID: 4c743e7fb9802b0046a440afef8b0f89c8562e5c
Timestamp Audit
June 29, 2022 9:20 am MSTNotice of Withdrawal Uploaded by Mike Kaminski - office@evsm.net IP