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2. Cancellation Request Form
4. Palm Beach Gardens Recreation
8. I understand that any applicable cancellation fees will automatically be withdrawn from the refund amount.*

   1. Yes
12. Program Information
14. Program/Activity Name:*
15. Program/Activity Location:*
    -- Select One --Burns Road Community CenterGardens District ParkPalm Beach Gardens Tennis & Pickleball CenterPBG Aquatics ComplexPGA National ParkRiverside Youth Enrichment CenterOther
17. If other, please list the location of the program/activity:
19. Please explain the reason for requesting the cancellation.*

    Documentation, such as the original receipt or doctor's note, can be attached at the bottom of the form.

23. Household/Account Information
25. Household/Account Number, if known:

    This number will be on your original receipt and at the top of your online account.  Supplying this number will expedite the request.  

27. Best Phone #:*
28. Best Email Address:*
30. Participant Last Name:*
31. Participant First Name:*
33. Parent/Guardian Last Name:*

    Type N/A if the participant is an adult.

34. Parent/Guardian First Name:*

    Type N/A if the participant is an adult.

38. Documentation
40. Attach any pertinent documentation such as original receipt, doctor's note, etc.
42. Attach any other pertinent information such as original receipt, doctor's note, etc.
Leave This Blank:


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

    This field is not part of the form submission.

46. Submit

* indicates a required field