2023-2024 Withdrawal Form (Stratford Rotary Hockey League)

Print 2023-2024 Withdrawal Form

Player Information

Date of Birth^*

Date format: MM / DD / YYYY

Date of Last Practice or Game Attended

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 September 1, 2023.
- After September 1st, a $25 admin fee plus $20 per scheduled ice time (game or practice) will be deducted from fees prior to refund.
- Additional administrative fees may also apply

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 2023-2024 season.

I agree to the terms and conditions stated above^*

Human Validation