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2. City of Yorba Linda Parks & Recreation Department

   Program Refund Request Form

4. Participant Name*
6. Program Name*
7. Course Number
9. Number of Classes Attended*
10. Reason for Cancellation*
    -- Select One --Medical/IllnessNot Satisfied with CourseScheduling ConflictOther (Please Include Reason in Field Below)
12. Reason for Cancellation/Additional Comments
14. All refunds will be issued to the original method of payment unless indicated otherwise below.

    1. Please issue my refund in the form of an account credit on my online account instead of the original payment method.
16. Name of Person Making Request*
18. Contact Phone*
19. Contact Email*
21. Thank you for submitting a request. Eligible requests are typically processed in 2-3 business days.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field