Community Services Refund Request Form (BHReg)

City of Beverly Hills | Community Services Department
Refund Request Form

Community Services Registration Office

Phone: 310.285.6850 | BHReg@beverlyhills.org

Office Hours 8:30am - 4:30pm M-F
Main Account Holder's Name:*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Number*
Please enter a valid phone number.
Account Email/Username*
example@example.com
Activity Session Period*
Refund Request*
Click '+ Add Request' to add additional requests.
What is the reason for the refund?*
Upload additional documentation

Medical Reason - Please upload Doctor's Note
Cancelof
Provide comments about this refund request:*
PARENT/LEGAL GUARDIAN REFUND AGREEMENT*

By checking this box, as the parent/guardian of the participant above, I verify that the information is accurate. A refund fee of $13 may apply. (Summer Camp fees applied per child per camp)
Please verify that you are human*
Parent/Guardian Signature*

Clear
Should be Empty:

City of Beverly Hills | Community Services Department