IRVINE ART & MUSIC : WITHDRAWAL CONTRACT

Parties Involved

Student Name: Parent/Guardian Name: Teacher Name:

Reason for Withdrawal: Date of Last Lesson: Notice Date:

By signing this contract, the undersigned parties agree to the following terms:

The parent/guardian acknowledges the withdrawal of the student from Irvine Art & Music effective on the date of the last lesson specified above.
The teacher confirms that all lessons up to the last lesson date have been provided as agreed.
Any outstanding balance must be settled prior to the finalization of this withdrawal, unless otherwise noted by staff.
This contract terminates any ongoing obligations between the parties related to lessons after the last lesson date.

Parent/Guardian Signature: Date:

Teacher Signature: Date:

Staff Initials: Outstanding Balance:

Yes No

Additional Notes:

Autopay OFF Auto-Invoice OFF Recurring OFF