Required fields are marked with asterisks (*)

Refund Request Form

*Please note that refunds/credits on account will not be issued for programs if three (3) or more classes have occurred

I understand and agree to the Refund Policy listed above

Yes, I agree

Payable To:

Date

Participant Information

Participant Name:

Address:

Town / City:

Postal Code:

Phone Number:

Course / Program Name:

Course / Program Code:

Couse / Program Location:

Course / Program Start Date:

Course / Program Time:

Reason for Refund/Credit Request:

If approved, how would you like the funds returned?

Account Credit to my Recreation Account (can be used for future programs/services)

Refund by Credit Card (when original payment was made by Credit Card, or financial information is available on account)

Refund by Cheque (please allow up to four weeks for processing)

Full Name:

Email Address

Signature

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