APP Coach Application Form

Registration Fees--Refund Request

Costa Mesa Soccer--AYSO Region 120

Season you are requesting a refund for:

Name of child you are requesting a refund for:

Child's Last Name
Child's First Name

Your Contact Information:

Last Name
First Name
Relation to Child
Street Address
City
Zip Code
Phone Number
Email Address*

* MAKE SURE YOU'VE ENTERED A VALID EMAIL ADDRESS: Confirmation of receipt of this request will be emailed back to you. Failure of delivery or failure of you to respond will halt the refund process.

Describe your reasons for requesting a refund:

Fall Season

100% refund for a written refund request received by July 1st
50% refund for a written refund request received by August 1st.
NO REFUND given after August 1st

Spring Season

100% refund for a written refund request received by February 1st.
50% refund for a written refund request received by March 1st
NO REFUND given after March 1st

(Refund Checks are usually processed and issued within 30 days from receipt of a valid request. )

BY SUBMITTING THIS REFUND REQUEST, I HEREBY CERTIFY THAT I AM THIS CHILD'S PARENT OR GUARDIAN AND AS SUCH AM ENTITLED TO THE REQUESTED REFUND. I ALSO ACKNOWLEDGE THAT I HAVE READ AND AGREE TO THE ABOVE REFUND POLICY.