Refund / Prorate Request Form

Please note:

Request must be submitted seven (7) days prior to course begin date.
Please allow up to 30 days for refund to be processed.
For more details, please review The Brushy Creek Camp and Recreation Program Refund Policy

Account Information

Last Name

First Name

Phone Number

Email Address

Street Address City and Zip Code

Participant Information

Participant Last Name

Participant First Name

Course Name

Course Activity Number

Fee

If Other state reason

If Prorate Total Course Sessions

If Prorate Total Sessions Attended

Customer Signature

Instructor must sign before refund or proration can be processed (if applicable). Once you submit this request, request will be submitted to instructor for sign-off.