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Withdrawal Form

To go on hold or withdraw completely from lessons at Flourish Music Academy. Withdrawal requires 2 weeks notice.

Student Name(s)*
Parent email (or yours if you are an adult student)*
I would like to*
- Go on hold and return to lessons later
- Withdraw from my membership at Flourish completely
You can go on hold for up to 2 months, for a one-time $40 hold charge. The hold allows you to continue lessons later without paying the $50 registration fee again (plus potentially the $90 annual membership fee). On hold, you maintain your status as an active student and its benefits. You will keep any makeup credits and can sign up for open lesson slots even during your hold period. You will also maintain access to resources such as online theory games. You are eligible for one hold per calendar year.
What date will you be stopping lessons?*
Withdrawal date must be a minimum of 2 weeks from today's date. No refunds are given for previously paid tuition.
- End of this month
What month will you start your hold?*
Hold starts on the 1st of the month. No refunds are given for previously paid tuition.
- Next month
I would like my hold to last for:*
- 1 month
- 2 months
After the specified hold period, auto-pay tuition will resume. Up to two weeks before lessons resume, I can contact the office to schedule my new lesson time.
I understand my previous lesson time cannot be guaranteed when I return to lessons. Also, while I am on hold I will continue to receive student newsletters so I can get priority access and scheduling on upcoming events and lessons when I return. Any newsletters not applicable to me I can ignore.*
I understand.
I will lose any makeup credits by withdrawing entirely, plus I will need to pay the $50 registration fee again if I decide to return to lessons.*
I understand.
Why have you decided to pause or un-enroll from lessons at Flourish?*
To help us better serve the community of Greeley and the surrounding area, we appreciate your time to answer the following questions.

How would you rate Flourish in the following categories based on your experiences?

	Needs Improvement	Fair	Satisfactory	Great	Beyond Expectation!
Teachers
Performance Events
Group Lessons/Community Week(K-12 students)
Flourish Achievement Program (K-12 students)
Practice Challenge (K-12 students)
Extra resources like Sight-reading Library and Tonictutor.com
Friendly Customer Service
Clear Communication
Ease of Online Calendar to cancel or schedule makeup lessons

Are there any other problems you have experienced related to lessons, scheduling or other aspects of your membership at Flourish?

How would you rate your teacher in the following areas?

	Needs Improvement	Fair	Satisfactory	Great	Beyond Expectations
Friendly and encouraging
Challenges me to do my best
Quickly identifies the problem I am struggling with and provides solutions
Teaches me new concepts in a way I understand
Shows up on time and acts professionally
Inspires me so that I am now enjoy music more

Do you have any additional comments on your teacher?
What is the largest benefit you have gained from studying at Flourish?
How likely would you be to recommend Flourish to a friend?
- 5 (very likely)
- 4
- 3
- 2
- 1 (not likely)
Would you be willing to give Flourish a short review on Google or Facebook before you go?
- Sure!
- No thanks

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LOCATION

Flourish Music Academy
2170 35th Ave, Suite D
Greeley, CO 80634

Serving the Northern Colorado area, including Greeley, Evans, Eaton, Windsor, Johnstown, Milliken, Ault, LaSalle, Kersey, Loveland, Fort Collins, Platteville and more!

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