2. Hanover County Parks & Recreation
4. Refund Request Form
8. Full refunds will be issued for programs that are full or cancelled by the department, if a change in day, time or location prohibits participant’s attendance, or if participant withdraws prior to the first class meeting.
   If a participant wishes to withdraw from a class/program after the first meeting date, they must do so within two business days, and their refund is subject to a $5 processing fee.
   Refund requests will not be considered once a program has ended.
   Refund requests may be considered on a case by case basis.
   Refunds may take up to four weeks to process.
12. Check made payable to (Name)
14. Address
16. City
17. State
18. Zip Code
22. Participant Name
24. Activity Name
26. Activity Code
27. Fee
29. Reason for refund

    1. Medical/illness prior to first class meeting
    2. personal conflict prior to first class meeting
    3. Other prior to first class meeting (please explain below)
    4. unsatisfied with class
    5. medical/illness after class starts
    6. personal conflict after class starts
    7. Other after class starts (please explain below)
31. Explanation for other in reason for refund
33. Comments
35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature
38. Date
    Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

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