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 Region 58
Van Nuys / Sherman Oaks

 Refund Request and Dropped Player Notification:

In order to request a refund of registration fees, and to notify us of a dropped player, all fields MUST be completed as noted below. Complete the form ONLY once for each child, and only include the information for one child on each form. (All refund requests are subject to eligibility under the Region's Refund Policy located HERE.):

Player First Name: * Player Last Name: *
Date of Birth (mm/dd/yyyy, e.g., 03/01/2001): *

Gender: *
     Boy
     Girl

Parent Name: *
Your Email: *

Your Phone No: *

Cell/Alternate Phone No:


Refund Request Information*
All of the information below is REQUIRED for a refund to be processed (1)


Make Refund Check Payable to: *

Address for check to be mailed: *

City, State, Zip code for check to be mailed: *


Comments:


                               

* Required field.

(1) Subject to Regional Refund Policy located HERE.):

 
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