Cancellation Request Form - Lake In The Hills Parks & Recreation Department
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Lake in the Hills
Parks & Recreation Department
Cancellation Request Form
Activity cancellations are subject to a $5.00 processing fee per household. Policies governing cancellations are printed in
each brochure on the page adjacent to the registration form. Please refer to these policies prior to completing this form. Camp
and Playschool refund policies are published in the seasonal brochure. See below for facility cancellation policy. Please allow
up to 4 weeks for receipt of refund. Please email completed form to .
Name of Payee ________________________________
Submittal Date ________
Address ___________________________ City ________________________ Zip ____________
Home Phone ________________ Work Phone __________________ Cell Phone ______________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Activity Code you wish to cancel _________ Program Title _____________________________
Name of person(s) registered in class/program ___________________________________________
___________________________________________
Brief explanation of cancellation ______________________________________________________
_________________________________________________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Facility Rental location you wish to cancel ______________________________________________
Scheduled date of rental ______________________ Brief explanation of cancellation ___________
_________________________________________________________________________________
Facility Cancellation Policy:
•
The refundable cleaning/damage deposits will be returned if a rental is canceled.
•
14 days prior to the date of rental no refunds will be issued.
•
15 to 30 days prior to the date of rental a 25% rental fee refund would be issued.
•
31 to 60 days prior to the date of rental a 50% rental fee refund would be issued
•
61 days prior to the date of rental a full refund minus a $5 service fee will be issued.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For the cancellation refund to be processed, you must read and initial ALL of the following:
____ I understand that cancellations/refunds cannot be considered unless submitted to the
registration office in writing prior to the start of a class/program.
____ I understand that no cancellation/refund/ transfer is considered for classes missed or forgotten.
____ I understand that no cancellation refunds will be considered after the second class.
____ I understand that only a prorated portion of a class/program (plus the $5 service fee) will be eligible
for refund if the cancellation request is made after the first class but prior to the second class.
____ I understand that no cancellation refunds will be issued for special events or activities requiring a
registration fee.
____ I understand that no cancellation refunds will be issued for trips, unless the seat can be filled by
someone on the waitlist for that trip.
____ I understand that a full refund/transfer will be issued for any class/program that is cancelled by
the Lake in the Hills Parks & Recreation Department.
____ I understand that camp and preschool cancellation refunds are unique as published in the seasonal
brochure.
____ I understand that cancellation refund requests due to medical reasons must be accompanied by
physician documentation.
________________________________________________
Signature
Date
Original Amount Paid $______
Method of payment ________
Amount of Approved Refund $______ Refund Process Date ________
Staff Initials ______
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