New Submission

Primary Account Holder/Responsible Guardian

	First Name*field type single line	Last Name*field type single line
row 1	First Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Last Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.

field type checkbox
Company
Company Name:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

	Address*field type single line	City*field type single line	State*field type single line	Zip*field type single line
row 1	Address*field type single line Input blocked. Maximum character limit of 4000 characters reached.	City*field type single line Input blocked. Maximum character limit of 4000 characters reached.	State*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Zip*field type single line Input blocked. Maximum character limit of 4000 characters reached.

Phone Number*field type number Email Address*field type email
row 1 Phone Number*field type number
Email Address*field type email
0
Reason for request*field type radio button
Reason for requestChampions Club Membership Type AdjustmentChampions Club Membership CancellationChampions Club Locker CancellationClass/Program Transfer or RefundFacility Rentals/Party Transfer or RefundSenior Activity Center Membership CancellationSouthlake Pickleball Complex Class or Membership

	Phone Number*field type number	Email Address*field type email
row 1	Phone Number*field type number	Email Address*field type email

Southlake Pickleball Complex Membership Cancellation

Memberships are non-refundable. A CAR form must be submitted at least seven days prior to the next auto payment date in order to stop the payment from being processed. The City shall set all passes requested for non-renewal for the next billing date. Members may continue to use the membership through the date already purchased. The City will not issue prorated refund for memberships.
Membership Type*field type drop-down
Reason for Request*field type radio button
Reason for RequestDo not utilize membershipRelocating/MovingTravelUnsatisfied with member amenities/programsUnsatisfied with facility/equipmentSelected other service providerFamily and/or health emergencyOther

Champions Club Membership Type Adjustment

Customer is responsible for any fee difference (i.e. Adult to Family membership). The updated monthly fees are due immediately and membership type adjustment will take place when the fees are paid. When adjusting to a membership type with a lower fee, no refund will be given and the membership type will be adjusted on next scheduled billing cycle.
Current Membership Type*field type drop-down
New Membership Type*field type drop-down
*This is only a request. Additional documentation may be required.

Temporary Champions Club Membership Suspension

For individuals who are not yet comfortable with returning to Champions Club we have implemented a temporary membership suspension program. Memberships are eligible for 30 or 60 day suspensions. Email confirmation will be sent once suspended.
As of 3/1/21, members currently on suspension are eligible for one additional 30, 60 or 90 day suspension renewal. After the suspension renewal period has ended the membership will automatically reactivate.
New suspensions requested 3/1/21 or later will automatically reactivate at the end of the suspension period.
Membership Type*field type drop-down
Suspension Duration*field type radio button
Suspension Duration30 days60 days90 days
Do you have a Locker Rental?*field type radio button
Do you have a Locker Rental?NoYes
Reason for Request*field type radio button
Reason for RequestTravelFamily and/or health emergencyOther

Champions Club Membership Cancellation

Memberships are non-refundable. A CAR form must be submitted at least seven days prior to the next auto payment date in order to stop the payment from being processed. The City shall set all passes requested for non-renewal for the next billing date. Members may continue to use the membership through the date already purchased. The City will not issue prorated refund for memberships.
Membership Type*field type drop-down
Are you curently renting a locker?*field type radio button
Are you curently renting a locker?YesNo
Reason for Request*field type radio button
Reason for RequestDo not utilize membershipRelocating/MovingTravelUnsatisfied with membership amenitiesUnsatisfied with facility/equipmentSelected other service providerFamily and/or health emergencyOther
Cancellation Reason Comments*field type single line
Please let us know if there was a service or amenity that Champions Club could provide that would have prompted you use and retain your membership
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Cancellation Reason Comments*field type single line
Please let us know which provider you selected and why so that we can improve for the future.
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Cancellation Reason Comments*field type single line
Please let us know what amenity or services you were unsatisfied with so that we can improve for the future.
Input blocked. Maximum character limit of 4000 characters reached.

Locker Information

Locker rentals are non-refundable. Locker cancellation requests must be submitted at least seven (7) days prior to the next auto payment date in order to stop the payment from being processed. The City shall set all locker rentals for non-renewal for the next billing date. Members may continue to use the locker rental through the date already purchased. The City will not issue prorated refunds for locker rentals.
Locker Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Locker Room*field type radio button
Locker RoomMen'sWomen's
Reason for Request*field type radio button
Reason for RequestDo not utilize LockerRelocating/MovingTravelUnsatisfied with membership amenitiesUnsatisfied with facility/equipmentSelected other service providerFamily and/or health emergencyOther

Class/Program Transfer or Refund

Specific Program Refund Policies:
Only one cancellation/transfer request shall be allowed per original transaction. Therefore, a transaction shall not be transferred and then cancelled and receive any refund amount.
Customers shall submit a refund or transfer request at least seven (7) days prior to the program start date.
The City shall not issue a refund after this date. A ten dollar ($10) administrative fee may apply per registration item refunded. For Camp Mania, Cross Timbers Nature Camp, Cross Timbers Forest Preschool, Club Metro Camp and Learn to Swim Lessons a forty dollar ($40) administrative fee shall apply per registration item refunded. For individual athletic league registrations, a twenty five dollar ($25) administrative fee shall apply per registration item refunded if a uniform order has been placed prior to the refund request.
The City shall not issue a refund for athletic team fees after the City releases the league schedule.
Personal training, small group training and private lesson packages are non-refundable and non-transferable.
If the customer submits a request within thirty (30) days of registration for any fees previously paid at a rate other than the customer’s eligible rate, the City shall adjust and refund the difference.
The administration fees do not apply to programs with registration fees of twenty dollars ($20) or less.
Please select program location:*field type radio button
Please select program location:Champions ClubRecreation ProgramSenior Activity CenterSouthlake Pickleball
Type of Request*field type radio button
Type of RequestTransferRefund

Transfer From

	Participant First Name*field type single line	Participant Last Name*field type single line	Activity Name*field type single line	Program Start Date*field type date
Row 1×	Participant First Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Participant Last Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Activity Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Program Start Date*field type date	×

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Transfer To

	Participant First Name*field type single line	Participant Last Name*field type single line	Activity Name*field type single line	Program Start Date*field type date
Row 1×	Participant First Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Participant Last Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Activity Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Program Start Date*field type date	×

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Refund Request

	Participant First Name*field type single line	Participant Last Name*field type single line	Activity Name*field type single line	Program Start Date*field type date
Row 1×	Participant First Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Participant Last Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Activity Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Program Start Date*field type date	×

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Payment Method Request:*field type radio button
Payment Method Request:Original Payment Method
Reason for Request*field type radio button
Reason for RequestRelocating/MovingTravelUnsatisfied with programUnsatisfied with instructorScheduling ConflictFamily and/or health emergencyOther

Facility Rentals/Parties Transfer or Refund

Please select rental location;*field type radio button
Please select rental location;Champions Club at The Marq SouthlakePark Pavilion or FieldLegends Hall at The Marq SouthlakeSouthlake Pickleball Complex
In the event of cancellation by customer, deposits shall be refunded. The City shall issue a full refund if the request is at least seven (7) days prior to the rental date. The City shall not issue a refund after this date.
For transfers, customers shall submit the transfer request three (3) days prior to the rental date. The customer shall schedule the new rental date at the time of the transfer request. In the event of inclement weather on the rental date (outdoor reservations only), the City shall grant a transfer if the customer requests within three (3) days after the rental date. Only one cancellation/transfer request shall be allowed per original rental. Therefore, a rental shall not be transferred and then cancelled and receive any refund amount.
In the event of damages or overages, the City shall apply the deposit to the applicable charges. For damages totaling greater than the deposit amount, the City shall bill the customer for the remaining balance.
In the event of cancellation by customer, deposits shall be refunded. The City shall issue a full refund if the request is at least seven (7) days prior to the rental date. The City shall not issue a refund after this date.
For transfers, customers shall submit the transfer request three (3) days prior to the rental date. The customer shall schedule the new rental date at the time of the transfer request. In the event of inclement weather on the rental date (outdoor reservations only), the City shall grant a transfer if the customer requests within three (3) days after the rental date. Only one cancellation/transfer request shall be allowed per original rental. Therefore, a rental shall not be transferred and then cancelled and receive any refund amount.
In the event of damages or overages, the City shall apply the deposit to the applicable charges. For damages totaling greater than the deposit amount, the City shall bill the customer for the remaining balance.
For Court Reservations, the City shall issue a full refund if the request is at least forty-eight (48) hours prior to the reservation date. The City shall not issue a refund after this date. Transfers are permitted up to start time of reservation and may be requested via phone. The customer shall schedule the new reservation date at the time of the transfer request. In the event of inclement weather on the reservation date, the City shall issue a full refund.

For Group and Private Event Rentals, the City shall issue a full refund if the request is at least seven (7) days prior to the rental date. The City shall not issue a refund after this date. Deposits shall be refunded, if applicable. For transfers, customers shall submit the transfer request seven (7) days prior to the rental date. The customer shall schedule the new rental date at the time of the transfer request. Only one cancellation/transfer request shall be allowed per original rental. Therefore, a rental shall not be transferred and then cancelled and receive any refund amount.
Type of Request*field type radio button
Type of RequestDate, Location and/or Time Transfer RequestRefundParty Package Transfer
Party Package Information
row 1
Add
Type of Party Package - Current*field type radio button
Type of Party Package - CurrentStandard PartyDeluxe Party
Type of Party Package - New*field type radio button
Type of Party Package - NewStandard PartyDeluxe Party

	Rental Date*field type date	Rental Time*field type time
row 1	Rental Date*field type date	Rental Time*field type time

Transfer From

	Rental Date*field type date	Rental Start Time*field type time	Rental End Timefield type time	Rental Location*field type single line
row 1	Rental Date*field type date	Rental Start Time*field type time	Rental End Timefield type time	Rental Location*field type single line Input blocked. Maximum character limit of 4000 characters reached.

Transfer To

	New Rental Date*field type date	New Rental Time*field type time	New Rental End Time*field type time	New Rental Location*field type single line
row 1	New Rental Date*field type date	New Rental Time*field type time	New Rental End Time*field type time	New Rental Location*field type single line Input blocked. Maximum character limit of 4000 characters reached.

Refund Request

	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line	Payment Method*field type radio button
row 1	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Payment Method*field type radio button Payment MethodCredit to AccountOriginal Payment Method

Refund Request

	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line	Payment Method*field type radio button
row 1	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Payment Method*field type radio button Payment MethodCredit to AccountOriginal Payment Method

Refund Request

	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line
row 1	Rental Date*field type date	Rental Time*field type time	Rental Space*field type single line Input blocked. Maximum character limit of 4000 characters reached.

Reason for Request*field type radio button
Reason for RequestRelocating/MovingTravelUnsatisfied with spaceUnsatisfied with serviceScheduling ConflictFamily and/or health emergencyOther

Refund Request

Date of Eventfield type date
Legends Hall Reason for Requestfield type single line
Input blocked. Maximum character limit of 300 characters reached.

Senior Activity Center Membership Cancellation

Memberships are non-refundable. For monthly memberships a CAR form must be submitted at least seven days prior to the next auto payment date in order to stop the payment from being processed. Membership may continue to be used up and through the date already purchased. Pro-rated refunds are not issued for memberships.
Membership Type*field type drop-down
Reason for Request*field type radio button
Reason for RequestDo not utilize membershipRelocating/TravelUnsatisfied with membership amenitiesUnsatisfied with facility/equipmentSelected other service providerFamily and/or health emergency - please specify belowOther

Attachment

Signature

Signature*field type signature Datefield type date
row 1 Signature*field type signature
Datefield type date
Date will be captured on form submission
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Customer Adjustment Request (CAR) Form

Primary Account Holder/Responsible Guardian

Attachment

Signature