|Sales| Cancellation + Transfer Request Form Header Image

UCLA Recreation Cancel, Refund, Transfer, and Add Services Requests

PLEASE CHOOSE THE PAYROLL DEDUCTION (PRD) RECREATION SERVICE YOU ARE REQUESTING TO ADD
PLEASE CHOOSE THE PAYROLL DEDUCTION (PRD) RECREATION SERVICE YOU ARE REQUESTING TO CANCEL*
Please identify which services this request applies to (Check all that apply)
Did you pay a fee for this course?*
I am a UCLA Recreation Employee completing this form on behalf of a customer

After the declaration of COVID-19 as a global pandemic by the World Health Organization, COVID-19 and its consequences are no longer unforeseen or unexpected. Please remember to carefully review UCLA Recreation's membership, program and fitness pass refund policy prior to purchase. 

Please review UCLA Recreation Cancellation and Refund policies before proceeding: https://recreation.ucla.edu/member-services


  • Transfers: If transferring to a program of the same price, the fee previously paid for activity #1 will be applied toward activity #2. If there is a balance due back to you, the money will be refunded per the refund policy schedule. We are unable to charge any additional fees, and therefore a refund and registration may be required.


  • Cancellations: Notification of all refund denials will be sent to the email address provided on this form.


  • Refunds: Submitting this form does not guarantee a refund.  Refunds for services originally paid in the last 6 months with a debit card, credit card or Bruin Card normally post within 10-15 business days.

Payroll Deduction must be canceled in writing via the online form and timestamped by the 10th day of the month to cancel your deduction for the following pay period. 

By cancelling your payroll deduction membership, you will also be cancelling enrollment in other services (Lockers, GroupX Pass, Household Adult membership, Household Adult Lockers ).

Customer Contact Information

Customer Name*
Please provide a USA phone number, as we are unable to contact international phone numbers
It is the customer's responsibility to ensure contact information is updated in their Recreation profile for future communication and updates.
Please list Student ID, Employee ID, or Rec ID. Please type "unknown" if you need assistance finding this number.
Current Mailing Address (USA Only)*
Current UCLA Campus Affiliation*
If you are a UCLA Student, please update your information through the Registrar's Office: https://www.registrar.ucla.edu/Student-Records/Personal-Information

Membership Cancellation - Refund Request

After the declaration of COVID-19 as a global pandemic by the World Health Organization, COVID-19 and its consequences are no longer unforeseen or unexpected. Please remember to carefully review UCLA Recreation's membership, program and fitness pass refund policy prior to purchase. 


To review UCLA Recreation Cancellation and Refund policies:: https://recreation.ucla.edu/member-services



This membership request applies to (Please check all that apply):*
Household Adult Name*
Dependent Name(s)*
Include quarter/dates of membership
Identify facilities you wish to have access to.
How did you pay for your 2020 membership/locker?
If you paid via payroll deduction, please do not submit form. All memberships paid for via payroll deductions were cancelled after our March 2020 campus closure and therefore no deductions have been taken since..
Recreation does not save credit card data past 6 months.*
Please log into to your UCPATH account to find ID number

Locker Rental Cancellation

Did you have a 2020 prepaid locker rental?
Do you wish to maintain your locker, and therefore committed to purchasing membership as soon as you are eligible.
How many lockers did you have in March 2020 at the time of our closure?

Fitness Pass & Instructional Programs

Virtual Fitness Pass, Private fitness training, Martial Arts, Dance, Art, Music, Tennis, Aquatics, Sports, etc
Identify the specific class/program you wish to transfer into if space is available.
Do you have ADDITIONAL Instructional Program cancellation or transfer requests?*
Private fitness training, Martial Arts, Dance, Art, Music, Tennis, Aquatics, Sports, etc
Identify the specific class/program you wish to transfer into if space is available.
How did you pay for your instructional Program?*
Confirming credit card used for original payment.*

Youth & Family Programs

Dependent/Camper Name (Please submit one form per camper)*
Transfers are dependent on availability of space and supplies.
Do you have additional Youth & Family cancellation or transfer requests?*
I have read and acknowledge all refunds are subject to the policy listed above. *
How did you pay for your Youth Program?*

Outdoor Adventures & Experiential Programs

Transfers are dependent on availability of space and supplies.
Do you have ADDITIONAL cancellation or transfer requests?*
Transfers are dependent on availability of space and supplies.

Marina Aquatic Center

$
Transfers are dependent on availability of space and equipment.
$
Do you have additional MAC cancellation or transfer requests?*
$
Transfers are dependent on availability of space and equipment.
$
How did you pay for the MAC program?*
Confirming credit card used for original payment.*

Club Sports - Cancellation

$
Clearly identify Club Admin Fee and Club Dues
Clearly define sport and gender of team.
How did you pay for your Club Sport(s)?*
Confirming credit card used for original payment.*
Date/Time
:  

Intramurals - Cancellation

By submitting this form, you are requesting a refund in the amount of $30. 

No partial refunds are offered.

Confirming credit card used for original payment.*
Date/Time
:  

Customer Feedback/Signature

Please share the reason(s) you are adjusting or cancelling your UCLA Recreation membership.*
Please share the reason(s) you are adjusting or cancelling your UCLA Recreation program or activity.*
I will provide a doctor's note that verifies inability to participate in the program.
Please share the reason(s) you are requesting to cancel your Club Sport or Intramurals activity*
Recreation Employee filling out form on behalf of customer
Use your mouse or finger to sign your signature above. If you have any questions, please contact our Sales & Service team (info@recreation.ucla.edu).
Use your mouse or finger to draw your signature above
Use your mouse or finger to draw your signature above

Add Fusion Detail

Sales & Service Rep Entering Data*
If unit approval is needed, please select unit to initiate a request in the workflow.
Request approval from:*
Identify the customer's enrollment (i.e Membership, Locker, Fitness Pass, Personal Training, Camp, Program, etc)
Full or partial refunds calculated here. Type "Needs approval" or N/A if no refund is available
Identify if this cost is due or to be refunded
Date/Time
:  

Unit Approval Request

Unit Employee Name*
Do you approve this cancellation/transfer request?*
$25.00 processing fee*
Please enter pretax refund amount. Type N/A if no refund is offered
Please be detailed as this will help the Sales & Cashiers team respond to this customer.
Date/Time
:  

Refund & Cancellation Completion

Sales & Service Staff Name
Actions Completed
Select all closing tasks you completed. I verify that the above actions have been completed today.
Date/Time
:  

Cancellation Completion

Sales & Service Staff Name
Date/Time
:  
Progress
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