Fort Lee Soccer Club
Fort Lee Soccer Club Refund Request Form
- For Recreation Winter Program
Refunds for the FLSC Winter Indoor programs apply only to the registration fees for the Recreation programs for the current year. Please fill out one form per player. All refund requests must be received by the FLSC and are prorated according to following schedule:
Refund request received by date
Registration fee refunded
(Check One)
Through December 14th
100%
After December 15th
80%
After January 1st
50%
After the start of the season
0% - No Refund
**Exceptions, i.e. health concerns / moving, will be handled on a per case basis**
Please complete all information and print clearly.
Refund Request Date: Month
Player’s Name:
/
Date
/
Year
Player’s Date of Birth:
Home Address: State:
Zip:
Father’s Name:
Tel#:
Work#:
Mother’s Name:
Email Address:
City:
Parent Information:
Reason of refund:
Amount Requested: (See chart above)
Today’s Date: Month
/
Date
Parent Signature:
/
We (I) certify that to the best of my knowledge the above information is true and accurate. Year
PLEASE RETURN THE COMPLETED FORM AND MAIL IT DIRECTLY TO: Fort Lee Soccer Club PO Box 3145, Fort Lee, NJ 07027
DO NOT WRITE IN THIS SPACE. FOR FLSC BOARD USE ONLY. Refund Request Received on date: Month
Amount Request: Approved by:
/
/
Date
APPROVED
NOT APPROVED
Year
Today’s Date:
Amount Approved: FLSC President Signature:
Fort Lee Soccer Club • P. O. Box 3145, Fort Lee NJ 07024 i n t o w n : w w w. f o r t l e e s o c c e r. c o m t r a v e l : w w w. f o r t l e e s c . c o m
Email : [email protected] Follow us on Facebook https://www.facebook.com/FortLeeSoccerClub
- For Recreation Winter Program
Refunds for the FLSC Winter Indoor programs apply only to the registration fees for the Recreation programs for the current year. Please fill out one form per player. All refund requests must be received by the FLSC and are prorated according to following schedule:
Refund request received by date
Registration fee refunded
(Check One)
Through December 14th
100%
After December 15th
80%
After January 1st
50%
After the start of the season
0% - No Refund
**Exceptions, i.e. health concerns / moving, will be handled on a per case basis**
Please complete all information and print clearly.
Refund Request Date: Month
Player’s Name:
/
Date
/
Year
Player’s Date of Birth:
Home Address: State:
Zip:
Father’s Name:
Tel#:
Work#:
Mother’s Name:
Email Address:
City:
Parent Information:
Reason of refund:
Amount Requested: (See chart above)
Today’s Date: Month
/
Date
Parent Signature:
/
We (I) certify that to the best of my knowledge the above information is true and accurate. Year
PLEASE RETURN THE COMPLETED FORM AND MAIL IT DIRECTLY TO: Fort Lee Soccer Club PO Box 3145, Fort Lee, NJ 07027
DO NOT WRITE IN THIS SPACE. FOR FLSC BOARD USE ONLY. Refund Request Received on date: Month
Amount Request: Approved by:
/
/
Date
APPROVED
NOT APPROVED
Year
Today’s Date:
Amount Approved: FLSC President Signature:
Fort Lee Soccer Club • P. O. Box 3145, Fort Lee NJ 07024 i n t o w n : w w w. f o r t l e e s o c c e r. c o m t r a v e l : w w w. f o r t l e e s c . c o m
Email : [email protected] Follow us on Facebook https://www.facebook.com/FortLeeSoccerClub
