This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
OPMI After School Request to Withdrawl Form
Please note that all fields followed by an asterisk must be filled in.
Parent/Guardian First Name*
Parent/Guardian Last Name*
Whispering Oak Elementary
Name of Music Class
Will your child be finishing out the month?
Reason for Withdrawal Request
Dissatisfied with program
Prefer not to say
If "other", please explain.
Confirmation of Withdrawal Request*
I confirm I would like to withdraw my child from the OPMI After-School enrichment class. I understand that no refund will be given for any classes my child can not attend this month.