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Canton Leisure Services Program & Membership 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. Requests submitted less than 24 hours-notice will not be considered.
4. Withdrawal Policy :
   • 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.

   • 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. Membership Cancellation Policy
   • Memberships are non-transferable and non-refundable
   • Requests for a refund due to medical reasons will be considered only if a doctor’s note is provided
   • Monthly Memberships will be cancelled within seven (7) days of completing this form
   • Early termination fees apply for Monthly Payment Plan Memberships and will be:
     • The pro-rated amount remaining on the membership OR
     • 50% of the remaining balance due, whichever is lesser for the member
10. I HAVE READ AND UNDERSTAND THE SATISFACTION/WITHDRAWAL POLICY*

    1. Yes
    2. No
12. Participant Name *
13. Date*
    Date
15. Participant/Guardian Name (if participant is a minor)
17. Home Phone
18. Cell/Work Phone
20. Email Address*
22. Address1*
24. City
25. State
26. Zip
28. Name of Class/Program:*
29. Activity Code:
31. I am requesting Leisure Services Credit on Account for (select one):*

    1. Program Withdrawal
    2. Program Satisfaction
33. Please explain why you are requesting a Program Withdrawal or were not satisfied with a program. class, or membership: *
37. Date Received by Program Supervisor
    Date Received by Program Supervisor
38. Approved / Denied

    1. Approved
    2. Denied
40. Amount If Approved:
41. Date Credit Place on Account, if Approved:
    Date Credit Place on Account, if Approved:
43. If Denied, Please List Reason:
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field