2020-2021 Withdrawal Form (Stratford Rotary Hockey League)

Print 2020-2021 Withdrawal Form

Player Information

First name^*
Last name^*

Date of Birth^*

Open the calendar popup.

Date format: MM / DD / YYYY

Address^*
Address 2
City^*
Postal Code^*
Primary Phone^*

Example: ###-###-####
Primary Email^*

PLEASE NOTE: Rotary Hockey uses email as it's primary method of communication with players. A copy of this submission will be sent to this address when complete.
Parent/Guardian Name^*
Is the information provided here the same as it was on your original registration?^*
YesNo
If answer is "No" - please provide explanation below
If answer above is "No" please provide explanation
Reason for Withdrawing:^*

Please provide a brief reason for this withdrawal request

REFUND POLICY:

No refund will be issued until this Withdrawal Form has been submitted.

- 100% refund for withdrawal requests received before November 1, 2020.
- After November 1, 2020, $20 per scheduled ice time will be deducted from fees prior to refund.

Stratford Rotary Hockey reserves the right to issue refunds in the same payment method that the original payment was received (ie: if you paid by credit card, the fees will be refunded to the original credit card).

By clicking below, you acknowledge the above and confirm your request to withdraw from Stratford Rotary Hockey for the remainder of the 2020-2021 season.

I agree to the terms and conditions stated above^*

Human Validation

Check The Box ^*

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Fri Jun 18, 2021

Printed from stratfordrotaryhockey.com on Friday, June 18, 2021 at 11:56 PM