Player Withdrawal and Refund Form

Rogers Park AYSO - Region 1206
PLAYER WITHDRAWAL AND REFUND FORM

This form is for use by parents or guardians who wish to withdraw their child from the Rogers Park AYSO soccer program. Submission of this form to the Registrar initiates the refund process.

WITHDRAWAL POLICIES: Withdrawal is effective immediately upon submission of this form to Rogers Park AYSO, not upon receipt of the refund. A child may not participate in the Rogers Park AYSO program once (s)he has been withdrawn. To request player reinstatement, the parent must contact the Registrar. We do not guarantee team placement - if you ask for reinstatement, your child may be re-assigned to another team. Coaches are not authorized to allow a withdrawn player to rejoin their teams.

A full refund is issued if you submit this form before the first game. A 50% refund is issued if you submit it after the first game. No refunds are issued after the second game. The refund will be processed and mailed to you in 4-6 weeks.

INSTRUCTIONS: Print this page. Print legibly. Complete and sign the form. Submit one form per child. Enclose the following documentation: (1) your copy of the child's AYSO registration form, and (2) a copy of your cancelled check (front and back) or cash receipt.

Mail this form and your documentation to:
Rogers Park AYSO Registrar
2547 W. Fargo
Chicago, IL 60645

I AM WITHDRAWING THE FOLLOWING CHILD FROM AYSO REGION 1206 - ROGERS PARK:

Name: _______________________________________________________________________________________________

Date of Birth: _________________________________________________________________________________________

CHECK THE APPROPRIATE BOXES:

c I am returning the AYSO uniform, clean, unused, and intact.

c I will keep the AYSO uniform.

c I did not receive an AYSO uniform.

c I am waiving my request for a refund - I will donate my refund to Rogers Park AYSO.

c I am requesting a refund for my child - mail the refund to:

Name: _______________________________________________________________________________________________

Street Address: ________________________________________________________________________________________

City, State, Zip: _______________________________________________________________________________________

Home Phone: ___________________________________________ Work Phone: _________________________________

Signature: __________________________________________________________ Date: ___________________________

OFFICE USE ONLY

Date Form Received _________________________________ Amount Refunded ___________________________

Copy to Treasurer ___________________________________ Check # ____________________________________

Copy to Division Manager ____________________________ Refund Check mailed on ______________________

Remarks ___________________________________________________________________

Rogers Park AYSO - Region 1206 PLAYER WITHDRAWAL AND REFUND FORM

Rogers Park AYSO - Region 1206
PLAYER WITHDRAWAL AND REFUND FORM