Refund Request

Refund Request
Date *

Month Day Year
Team
Program *
Player's Name *

First Name Last Name
E-mail
Parent Contact Email
Parent/Guardian *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Day Time Phone Number *

Area Code Phone Number
Alternate Phone Number

Area Code Phone Number
Original Payment Method *
Reason for Refund/ or Fee Adjustment *
Date Player Last Participated With Team:

Month Day Year
Date
Please upload documentation from a medical professional

Browse Files
You can submit at a later date, but this may be required before any Club Fee adjustment will be applied. Cancel of
Does the Player Intend to Return This Season?
If Returning, What Is The Current Best Estimate For a Return?
Additional Details Regarding Your Request *
Should be Empty: