2025-2026 Season

Withdrawal Notice

This form is used to officially notify MSDA that you wish to withdraw from the studio.

MSDA requires 30 days advance written notice to process a withdrawal from any class. Withdrawal requests submitted with less than 30 days notice are subject to a 30-day tuition charge. Please complete all fields below and submit this form to officially begin the withdrawal process. A staff member will follow up to confirm receipt.

Student Name

Parent Name

Phone Number

Email Address

Dancer's Location

Current Class Schedule

Please list each class the dancer is currently enrolled in. Include the day, class name, and time for each.

Class 1

Class 2

Class 3

Class 4

Class 5

Reason for Withdrawal

Will the dancer fulfill the 30-day notice period?

YesNo — I understand a final tuition charge may apply

Dancer's Last Day of Class

Parent/Guardian Signature

Date

Current Class Schedule

Notice Received