Refund form

Refund form
Player Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Reason for refund request*
Refund cheque should be made payable to :*
** If your refund request is due to injury:

All refund requests due to injury must be accompanied by a signed note from a Medical practitioner
that includes the following information;

1. Date the injury occurred
2. Nature of the injury
3. Medical Practitioner MUST indicate that the injury is season-ending for the player
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Should be Empty: