Form

First name*

Last name*

Phone number*

Students Name*

Email*

Type Class Terminating?*

Private Lesson Membership

Group Class in Person

Private Lesson Online

Group Class Online

Desired return date?

Year/Month/Day

Reason for Termination*

We value your feedback. Could you expand on your reasoning?*

Instructor Name?

How did you like your Volta Dance instructor?

What did you like overall about our School, Classes, Facilities, & Team?:*

What did you dislike? Please let us know how we can improve. (Specifics are great):*

Electronic Agreement:

I understand I will be charged through the end of the 30 Day Notice submission date (30 days from the date this email form is submitted); If student Last Day of Classes is more than 30 days from today, I understand I will be charged through the Last Day Date of classes.

Electronic Signature:*