[City of Cleveland] Refund Request

Date

Phone Number

Alternate Phone Number

Name of child/ children and ages

Reason for Refund Request

Requested Refund Amount

NOTE: The Refund will NOT include the convenience fee if the registration fee was initially paid online.

Refund Amount

Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.