Iowa Rush South - Refund Request Form
This request form must be completed in its entirety before it will be reviewed by Iowa Rush South board members to determine if a refund or partial refund is approved or possible based on what the registration was for, the refund policy stated during that registration, the timing of the refund request to when the soccer program begins, and any circumstances beyond control such as injury or moving from the Pella location.
  • Enter the name of the player who was registered for an Iowa Rush South program.
  • / /
    Enter date of birth of player - example 05/03/2010.
  • The person submitting this form must be a parent or guardian of the player who was registered.
  • Select the soccer program that this player is registered for that you are requesting a refund for.
  • Please be sure to include any additional information needed to make the form official such as a detailed Medical Note stating diagnosis of injury or extended illness, etc.. A form can be uploaded with this form separately.
  • Upload a medical note from a doctor if stating diagnosis of injury or extended illness, etc..

    The BELOW section is for Iowa Rush South use only - DO NOT ENTER information BELOW THIS SECTION.
  • Payment Information === FOR CLUB ADMINISTRATION ONLY ===

    To be entered by Iowa Rush South Registrar/Admin for tracking purposes.
  • $ .
    Do not include Payment Plan not paid.
  • $ .
  • $ .
    If a reimbursement is approved, it will be less the Administriative Fee and any other fees that the Iowa Rush South has already paid out to the City of Pella, Iowa Rush, or Iowa Soccer, etc..