Adventure Camp Withdrawal Form

Adventure Camp Withdrawal Form

City of Beverly Hills Community Services Department
Adventure Camp Admin Office

Phone: 310.285.6810 | AdventureCamp@beverlyhills.org

Office Hours 9:00am - 4:00pm M-F
Student's Name*

First NameLast Name
Grade*
School*
Account Email/Username*
example@example.com
Main Phone Number*
Parent's Name*

First NameLast Name
PAYMENT POLICY:

Parents/guardians who withdraw their child during the current billed month will not receive any credit or refund - no prorated fees.
Reason for Withdrawal:*
If you are canceling only the TK/K extended care, your child will still be on the roster to attend the program until 4pm.
Last Day Attending Adventure Camp*

MonthDayYear
Date
Customer's Signature*

Clear
Please verify that you are human*
Should be Empty: