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Request for Monthly Pass Cancellation Form
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Terms and Conditions of Cancellation Policy
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- Evergreen Park & Recreation District requires a 30-day notice for all monthly facility passes to be cancelled; meaning an additional payment will be taken if this request is submitted after the first of the month.
- If you have not met the minimum requirement of 3 full months of payments, additional payments will be taken to equal 3 months of payment in full, prior to the cancellation of the pass.
- Any past due amounts will be collected at the time of the final payment.
I have read, understand and agree to the terms and conditions of the cancellation policy listed above.
Which type of monthly pass are you cancelling?
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-- Select One --
Youth
Adult
Military/Senior
Couples - Adult
Couples - Military/Senior
Family of Four
Family of Four - Military
Name of person completing cancellation form:
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List of all other additional pass holders (if applicable):
Email Address
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Primary Phone Number
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Please read and acknowledge the following statements:
Acceptance Required
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I acknowledge I may be charged the next monthly payment, as it is required to give 30 days notice of cancellation.
Acceptance Required
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I understand by cancelling my monthly facility pass, I and all other pass holders will be subject to fill out a new facility pass agreement in person at either Buchanan Park or Wulf Rec Center.
Reason for Cancellation
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Electronic Signature Agreement
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By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.
I agree
Signature (First, M. Last)
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