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2. REFUND REQUEST FORM MUST BE SUBMITTED AT LEAST FIVE (5) BUSINESS DAYS PRIOR TO EVENT/ACTIVITY
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email*
    Refund request approval or denial will be sent to this address.
17. I am requesting a refund for:*

    1. Facility Rental
    2. Class/Program/Event Registration
19. Name of Person/Organization Rental Was Paid By
21. Name of Facility Rented
23. Rental Date
    Rental Date
24. Rental Time
    Rental Time Start Time

    —

    Rental Time End Time
26. First Name of Participant Being Refunded
27. Last Name of Participant Being Refunded
29. Class/Program/Event Refund is Being Requested For
31. Location of Class/Program/Event
32. Session Refund is Being Requested For
    If applicable
34. Refund Justification*
    Please describe the medical reason or extraordinary circumstances causing a need for refund
36. Supporting Documentation*

    1. I have attached documenation to this request
    2. I will deliver documentation to the Recreation Department Main Office
38. Supporting Documentation
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field