Request for Withdrawal & Refund (Lakefield District Minor Hockey)

Print Request for Withdrawal & Refund

Please fill in all applicable fields. Any requests for Refunds received prior to Friday of every week will be processed and available for pick up on the following Monday morning.

Player Information

Please fill in all fields.

Player Name^*
Player Address^*
Level of Play^*

What level of hockey is your player registered for? (Tyke, Bantam, etc.)
Contact Phone Number - Home^*

Example: ###-###-####
Contact Phone Number - Mobile^*

Example: ###-###-####
Email Address^*

Example: [email protected] Your submission will be sent to this address.

Reason for Withdrawal/Refund

Please provide specific details for reason for request.

Reason for Request ^*

Details required.

Please note:

By submitting this form, the LDMHA will consider this your official withdraw from our Association for the Current Season.

Your child/player will be immediately removed from our Registration and may not have the ability to return this season, depending on number of teams/registered players.

Agreeing to these terms is mandatory for the LDMHA to continue with your request.

I agree to the terms and conditions stated above^*

Human Validation