AHPD - Refund Request Form

Refund Request Form

This form must be completed for all refunds. It takes approximately four (4) to six (6) weeks to process a refund. It may take longer before the credit appears on the patron's credit card statement. *Category "8" requires an explanation. You must fill out fields before submitting this form! This refund is subject to a $5 service fee, see refund policy.
Reason	Requirement	Fee
1-Illness	Doctor's note	Pro-Rated
2-Moved from Arlington Heights	New address	Pro-Rated
3-Instructor recommendation	Instructor note	Pro-Rated
4-Schedule conflict	Refund form	Pro-Rated
5-Class closed	Refund form	None
Other*	Refund form	May be Pro-Rated
*Explanation:

Participant's Name
Program Title		Program Code

If this program was paid for by credit card the refund will be applied to that card.
If paid by check/cash, a check will be made payable to:

Contact Name	Phone	Email

Office Use Only: