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Canton Leisure Services Program Satisfaction/Withdrawal Form

2. COVID-19 Adjustments to Refund Policy
   Canton Leisure Services is mindful of the challenges caused by the uncertainty of the COVID-19 pandemic. For that reason, we are adjusting our refund policy, in the following ways: Participants wishing to withdraw from a class or program must complete this form and submit it at least 24 hours prior to the start of the program or event. <b>Requests submitted less than 24 hours-notice will not be considered. </b>

   Canton Leisure Services is mindful of the challenges caused by the uncertainty of the COVID-19 pandemic. For that reason, we are adjusting our refund policy, in the following ways: Participants wishing to withdraw from a class or program must complete this form and submit it at least 24 hours prior to the start of the program or event. Requests submitted less than 24 hours-notice will not be considered.

4. Withdrawal Policy :
   <ul><li><b>If approved, participant will receive a full refund via original method of payment (credit card or credit on account). </b>Credit on Accounts may be used for Leisure Services classes, programs and memberships (excludes Village Theater shows, Pheasant Run and Softball Leagues). </li><li>If classes/programs are cancelled by Canton Leisure Services, participants will receive a full refund via original method of payment (credit card or credit on account). </li><li>Participants requesting to transfer from one class to another must comply with the Withdrawal Policy and then request to be enrolled in the new class, if space is available (may also require Supervisor approval).</li><li>Participants that withdraw with less than 24 hours’ notice, more than three times, may be prohibited from registering for future programs. </li><li>Leisure Services reserves the right to modify this policy and to exclude classes and programs from it at any time.</i></ul>

   • If approved, participant will receive a full refund via original method of payment (credit card or credit on account). Credit on Accounts may be used for Leisure Services classes, programs and memberships (excludes Village Theater shows, Pheasant Run and Softball Leagues).
   • If classes/programs are cancelled by Canton Leisure Services, participants will receive a full refund via original method of payment (credit card or credit on account).
   • Participants requesting to transfer from one class to another must comply with the Withdrawal Policy and then request to be enrolled in the new class, if space is available (may also require Supervisor approval).
   • Participants that withdraw with less than 24 hours’ notice, more than three times, may be prohibited from registering for future programs.
   • Leisure Services reserves the right to modify this policy and to exclude classes and programs from it at any time.

6. Satisfaction Policy
   Canton Leisure Services is committed to providing the highest quality classes, programs and events for the Canton Community. If after purchasing a program or membership and you are not satisfied with the level of service and/or quality of the program, you may complete this form. All requests must be made within seven (7) days after the completion of the class or program. <ul><li><b>All approved requests will receive a refund via original method of payment (credit card or credit on account).</b> Credit on Accounts may be used for Leisure Services classes, programs and memberships (excludes Village Theater shows, Pheasant Run and Softball Leagues). </li><li> Leisure Services reserves the right to modify this policy and to exclude classes and programs from it at any time.</i></ul>

   Canton Leisure Services is committed to providing the highest quality classes, programs and events for the Canton Community. If after purchasing a program or membership and you are not satisfied with the level of service and/or quality of the program, you may complete this form. All requests must be made within seven (7) days after the completion of the class or program.

   • All approved requests will receive a refund via original method of payment (credit card or credit on account). Credit on Accounts may be used for Leisure Services classes, programs and memberships (excludes Village Theater shows, Pheasant Run and Softball Leagues).
   • Leisure Services reserves the right to modify this policy and to exclude classes and programs from it at any time.

8. I HAVE READ AND UNDERSTAND THE SATISFACTION/WITHDRAWAL POLICY*

   1. Yes
   2. No

10. Participant Name *

11. Date*
    Date

13. Participant/Guardian Name (if participant is a minor)

15. Home Phone

16. Cell/Work Phone

18. Email Address*

20. Address1*

22. City

23. State

24. Zip

26. Name of Class/Program:*

27. Activity Code:

29. I am requesting Leisure Services Credit on Account for (select one):*

    1. Program Withdrawal
    2. Program Satisfaction

31. Please explain why you are requesting a Program Withdrawal or were not satisfied with a program or class: *

35. Date Received by Program Supervisor
    Date Received by Program Supervisor

36. Approved / Denied

    1. Approved
    2. Denied

38. Amount If Approved:

39. Date Credit Place on Account, if Approved:
    Date Credit Place on Account, if Approved:

41. If Denied, Please List Reason:

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field