If discontinuing lessons for multiple students enter all the names here separated with a comma.
This question helps us determine if this is a temporary break (i.e. taking a break for the summer) but you plan on coming back at a later time or not.
Note: No further invoices will be issued after the effective date selected above. However, lessons that have been prepaid before the submission of this form will not be refunded.
I understand that any make-up lessons not scheduled before the "Effective Date" will not be refunded.
Let us know if there is anything that Ampersand Music School can do to improve its services.