Canton Leisure Services
Camp Withdrawal/Transfer Form
**Please read our Policies below prior to filling out this form**
Withdrawal Policy
Participants wishing to withdraw/transfer from a camp must complete the this form and submit it to the Summit Front Desk at
least fourteen (14) days prior to the start of the week or day you are requesting. Requests submitted less than fourteen (14)
days will not be considered.
If approved, participant will receive a Leisure Services Credit on Account which may be used for Leisure
Services classes, programs and memberships (excludes Village Theater shows, Pheasant Run and Softball Leagues).
No cash or credit card refunds will be issued, unless camp is cancelled by Leisure Services.
Deposits (i.e. Camp Canton, Camp Leisure Club, Camp A.B.L.E.) will not be refunded, regardless if refund for the
camp is approved.
Participants requesting to transfer from one date to another must comply with the Withdrawal Policy and then request
to be enrolled in the new class, if space is available (may also require Supervisor approval).
Requests for a refund due to medical reasons will be considered at any time if accompanied with a doctor’s note.
Leisure Services reserves the right to modify this policy.
*I have read and understand the Satisfaction/Withdrawal Policy (signature):
Participant Name: Date:
Parent/Guardian Name (if participant is a minor):
Home Phone: Cell/Work Phone:
Email Address:
Address: City: Zip:
Name of Camp:
Day or Week of requested refund:
Please explain
why you are requesting a Program Withdrawal from camp:
Office Use Only
Date Received:_____________ Received by:________________ Approved / Denied (Circle) Amount Approved:______________
Completed by Front Desk Staff
Date Received:_____________ Received by:________________ Date Credit put on Account, if Approved:___________________
Completed by Program Supervisor
If denied, list reason:__________________________________________________________________________________________________
Camp Canton: $40.00 Cancellation Fee Per Week
B.L.O.C.K.: $20.00 Cancellation Fee Per Week
Camp Leisure Club & Camp A.B.L.E.: $15.00 Cancellation Fee Per Day
I understand that by checking this box, I am certifying that this is my signature, and that I have read and hereby agree to the
above Terms of Acceptance. Yes No
Revised 01/22/2020
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