Recreation Refund Request Form

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Parent's Name *

First and Last

Street Address *

ex. 123 Main St.

City, State, and Zip Code *

ex. Harrisonburg, VA 22801

Phone Number *

(xxx) xxx-xxxx

E-mail address *

Participant's/Player's Name *

First and Last

Player's Age Division *

ex. U5, U6, U7, etc.

Requested Amount to be Refunded *

Please note: Administration Fees ($7 if registration has not closed and $16 if registration has closed) are non-refundable

Reason for Refund *

Submit

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