Please complete this form and select the submit button.



Participant Information  

 Participant's Name(s)

 Person Responsible for Account:
 E-mail Address
 Home Phone


Activity Information

 Course Barcode # (s) 
 Course Title (s)

 Amount Paid, if known

 Number of Classes Attended

Reason for Withdrawal/Transfer (25 words or less please) :

REFUND POLICY: Unless otherwise stated, requested withdrawals will be approved upon
submitting this request at least FIVE BUSINESS DAYS PRIOR TO THE FIRST DAY OF CLASS.

A $20 administrative fee will be charged for processing refunds by check only.
A $5 administration fee will be charged for processing electronic refunds back to credit cards.

Please select the how you would like us to process any credit for this withdrawal/transfer:

Activity # to Transfer into or any additional comments

By submitting this form I authorize the Town of Danville Recreation Services to process  this withdrawal. I understand that if money is due to me, a check will be issued to my address on file within 4-6 weeks. If a credit card was the original form of payment, the  same card will be credited.