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Refund/Transfer Request

2. Today's Date:*
   Today's Date:

4. Contact Information

6. Parent/Payee Name:*

7. Email Address:*

9. Address:*

11. City:*

12. State:*

13. Zip Code:*

15. Day Phone:*

16. Evening Phone:

18. Participant's Name:*

19. Participant's Date of Birth:*

23. Class or Rental Details

25. Were you enrolled in a class or renting a facility?*
    -- Select One --Enrolled in a class.Renting a facility.

27. If enrolled in a class, please write name of class:

28. Instructor:

30. If renting a facility, please write name of facility:

32. Is this a request to refund or transfer your fee?*

    1. Refund
    2. Transfer

34. Reason for the Refund/Transfer:*

    For transfer requests, please provide as much information as possible about the preferred future program.

36. The reason for this refund/transfer is due to the COVID-19 response.

    1. Yes

38. Comments:

40. Signature:*

Leave This Blank:


42. Submit Submit and Print

* indicates a required field