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Request for Monthly Pass Cancellation Form
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Terms and Conditions of Cancellation Policy
- 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?
-- Select One --
Couples - Adult
Couples - Military/Senior
Family of Four
Family of Four - Military
Name of person completing cancellation form:
List of all other additional pass holders (if applicable):
Primary Phone Number
Please read and acknowledge the following statements:
I acknowledge I may be charged the next monthly payment, as it is required to give 30 days notice of cancellation.
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
Electronic Signature Agreement
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.
Signature (First, M. Last)
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