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Request for Monthly Pass Cancellation Form

  1. 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.

  2. Please read and acknowledge the following statements:*

  3. 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.

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  5. This field is not part of the form submission.