|Sales| Cancellation + Transfer Request Form

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

Please choose your cancellation request type*

Transfer, Cancel and/or Refund Recreation Service Cancel and/or Downgrade Payroll Deduction Service (Eligible UCLA Employees only)

PLEASE CHOOSE THE SPECIFIED RECREATION SERVICE*

PLEASE CHOOSE THE PAYROLL DEDUCTION (PRD) RECREATION SERVICE YOU ARE REQUESTING TO ADD

PRD Locker $5/month PRD BHIP $65/month PRD GroupX Pass In Person $15/month PRD Household Adult Membership $35/month PRD Locker Household Adult $5/month

PLEASE CHOOSE THE PAYROLL DEDUCTION (PRD) RECREATION SERVICE YOU ARE REQUESTING TO CANCEL*

Cancel ALL PRD Services PRD Membership ($35/mo) PRD Locker ($5/mo/locker) PRD BHIP ($65/mo/adult) PRD GroupX Pass In Person ($15/mo) PRD Household Adult Membership ($35/mo) PRD Locker Household Adult ($5/mo)

Please specify any additional details about your cancellation request here:

Please identify which services this request applies to (Check all that apply)

2020 Pre-paid Membership 2020 Pre-paid Locker Rental

Did you pay a fee for this service?*

No, it was free to enroll Yes, I paid an amount to enroll

I am a UCLA Recreation Employee completing this form on behalf of a customer

No Yes

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*

First Name

Last Name

Customer Daytime Phone Number*

Please provide a USA phone number, as we are unable to contact international phone numbers

Customer Email Address*

It is the customer's responsibility to ensure contact information is updated in their Recreation profile for future communication and updates.

Customer University ID Number*

Please list Student ID, Employee ID, or Rec ID. Please type "unknown" if you need assistance finding this number.

Current Mailing Address (USA Only)*

Address Line 1

Address Line 2

City

State

ZIP Code

Current UCLA Campus Affiliation*

UCLA Student UCLA Faculty / Staff UCLA Emeriti / Retiree UCLA Alumni Community Member

Has your contact information changed recently? If so, please identify what you'd like us to update in our system:

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):*

Myself My Household Adult My Dependent

Household Adult Name*

First Name

Last Name

Dependent Name(s)*

First Name

Last Name

Requesting to:

Specific Membership Type *

Include quarter/dates of membership

Desired Membership Type

Identify facilities you wish to have access to.

Please specify any additional details here

How did you pay for your 2020 membership/locker?

Cash or Check Credit Card

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.*

I understand that for purchases made beyond 6 months ago, I will be receiving a call from a Sales and Service representative to collect my payment method. For recent transactions, less than 6 months, I will get a refund back to the original payment if this request is approved.

UCPath ID Number

Please log into to your UCPATH account to find ID number

Employee ID Number

Locker Rental Cancellation

Did you have a 2020 prepaid locker rental?

Yes, I had a locker(s) No, this does not apply to me

Do you wish to maintain your locker, and therefore committed to purchasing membership as soon as you are eligible.

Yes, I am request to hold my locker(s) No, please cancel my locker(s)

How many lockers did you have in March 2020 at the time of our closure?

1 Locker 2 Lockers 3+ Lockers

Please identify the locker number and facility you wish to cancel*

For additional details, please specify here

Fitness Pass & Instructional Programs

Request 1: Identify the title, date(s) and time of the currently ENROLLED Instructional Program*

Virtual Fitness Pass, Private fitness training, Martial Arts, Dance, Art, Music, Tennis, Aquatics, Sports, etc

FOR TRANSFER REQUESTS: Identify the title, date(s) and time of the DESIRED Instructional Program

Identify the specific class/program you wish to transfer into if space is available.

Do you have ADDITIONAL Instructional Program cancellation or transfer requests?*

Yes, I'd like to make another cancellation/transfer request No.

Request 2: Identify the title, date(s) and time of the currently ENROLLED Instructional Program

Private fitness training, Martial Arts, Dance, Art, Music, Tennis, Aquatics, Sports, etc

FOR TRANSFER REQUESTS: Identify the title, date(s) and time of the DESIRED Instructional Program

Identify the specific class/program you wish to transfer into if space is available.

Please specify any additional details about your request here:

How did you pay for your instructional Program?*

Cash or Check Credit Card

Confirming credit card used for original payment.*

Original credit card is valid and not expired. Please process my refund (if applicable) using this same card. I would like the refund (if applicable) to be processed on a different card and will expect a phone call to collect credit card information within 3 weeks.

Youth & Family Programs

Dependent/Camper Name (Please submit one form per camper)*

First Name

Last Name

Identify the title and session dates of the enrolled Youth & Family program*

Identify the title and session dates of the desired Youth & Family program/class:

Transfers are dependent on availability of space and supplies.

Do you have additional Youth & Family cancellation or transfer requests?*

Yes, I'd like to make more cancellation/transfer requests No.

Request 2: Identify the title and session dates of the enrolled Youth & Family program

Identify the title and session dates of the desired Youth & Family program/class:

Request 3: Identify the title and session dates of the enrolled Youth & Family program

Identify the title and session dates of the desired Youth & Family program/class:

Request 4: Identify the title and session dates of the enrolled Youth & Family program

Identify the title and session dates of the desired Youth & Family program/class

Please specify any additional details about your request here

Youth & Family Cancellation + Transfer Policy

https://www.recreation.ucla.edu/youthprograms#948902517-refund-policies

I have read and acknowledge all refunds are subject to the policy listed above. *

I understand and agree.

How did you pay for your Youth Program?*

Online Payment In Person/Phone Payment Payment with Scholarship

Outdoor Adventures & Experiential Programs

Request 1: Identify the title, date(s) and time of the ENROLLED OA / Experiential Program*

Identify the title, dates(s) and time of the DESIRED OA / Experiential Program you wish to transfer into

Transfers are dependent on availability of space and supplies.

Do you have ADDITIONAL cancellation or transfer requests?*

Yes, I'd like to make another cancellation/transfer request No.

Request 2: Identify the title, date(s) and time of the ENROLLED OA/ Experiential Program*

Identify the title, dates(s) and time of the DESIRED OA / Experiential Program you wish to transfer into*

Transfers are dependent on availability of space and supplies.

Please specify any additional details about your request here

Marina Aquatic Center

Due to the nature of these impacted classes and full waitlists, transfers cannot be accommodated for programs at the Marina Aquatic Center.

Request 1: Identify the title, date(s) and time of the ENROLLED MAC program*

Amount paid for the enrolled MAC Program $

Identify the title, date(s) and time of the DESIRED MAC program

Transfers are dependent on availability of space and equipment.

Amount paid for the desired MAC Program $

Do you have additional MAC cancellation requests?*

Yes, I'd like to make another cancellation request No.

Request 2: Identify the title, date(s) and time of the enrolled MAC program

Amount paid for the enrolled MAC Program $

Identify the title, date(s) and time of the desired MAC program

Transfers are dependent on availability of space and equipment.

Amount paid for the desired MAC Program $

Please specify any additional details about your request here

How did you pay for the MAC program?*

Cash or Check Credit Card

Confirming credit card used for original payment.*

Original credit card is valid and not expired. Please process my refund (if applicable) using this same card. I would like the refund (if applicable) to be processed on a different card and will expect a phone call to collect credit card information within 3 weeks.

Club Sports - Cancellation

Requesting a Club Sport refund in the amount of* $

Clearly identify Club Admin Fee and Club Dues

Identify which Club Sport(s) you wish to cancel*

Clearly define sport and gender of team.

How did you pay for your Club Sport(s)?*

Credit Card Bruin Bill

Confirming credit card used for original payment.*

Original credit card is valid and not expired. Please process my refund using this same card. I would like the refund to be processed on a different card and will expect a phone call to collect credit card information within 3 weeks.

Date/Time

:

Intramurals - Cancellation

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

No partial refunds are offered.

Identify the quarter you enrolled into IMs for.

Confirming credit card used for original payment.*

Original credit card is valid and not expired. Please process my refund using this same card. I would like the refund to be processed on a different card and will expect a phone call to collect credit card information within 5 business days.

Date/Time

:

Customer Feedback & Signature

Please share the reason(s) you are adjusting or cancelling your UCLA Recreation membership.*

Moving out of area Health / Safety due to COVID19 No longer employed with UCLA Too expensive Did not adequately utilize membership Chose a different recreation center Parking Hours of operation / Capacity

Other:

Please share the reason(s) you are adjusting or cancelling your UCLA Recreation program or activity.*

Program did not meet my/dependent's need Class level did not meet expectations (too difficult / too easy) Timing did not work with my schedule Chose a different company/organization Too expensive, not worth the value Health / Safety due to COVID19 Illness / Injury

Other:

I will provide a doctor's note that verifies inability to participate in the program.

Please email a doctor’s note to info@recreation.ucla.edu within 2-3 business days of submitting your refund request for a review of an exception to our refund policy. No, choosing to skip and will be subject to the program's refund policy.

Please share the reason(s) you are requesting to cancel your Club Sport or Intramurals activity*

Team was waitlisted and I did not play in another league Schedule conflicts Price is too expensive Health / Safety due to COVID19

Other:

How can we improve our Recreation services for you or others in the future?

Recreation Employee filling out form on behalf of customer

First Name

Last Name

I verify I have reviewed UCLA Recreation's Refund Policies and I understand Recreation does not offer full refunds. I am confirming I would like to proceed with my cancellation request subject to the Recreation Refund Policy: https://recreation.ucla.edu/member-services*

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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).

I verify I have read and understood UCLA Recreation's Payroll Deduction Cancellation Policy: Payroll Deduction must be cancelled in writing and timestamped by the 10th day of the month to cancel your deduction for the following pay period. Any cancellation requests submitted after the 10th are subject to an additional month of deductions. No refunds.*

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Use your mouse or finger to draw your signature above

Add Fusion Detail

Sales & Service Rep Entering Data*

First Name

Last Name

Original Fusion Order #(s)*

Requires Unit Approval*

If unit approval is needed, please select unit to initiate a request in the workflow.

Request approval from:*

Youth & Family MAC: Nora Lee PFT: Liz Au Fitwell: Elisa Terry Rockwall / Experiential Programs Club Sports: Brett Billet Intramurals: Justin Chidester

Current Enrollment in Fusion*

Identify the customer's enrollment (i.e Membership, Locker, Fitness Pass, Personal Training, Camp, Program, etc)

Total Refund Amount*

Full or partial refunds calculated here. Type "Needs approval" or N/A if no refund is available

Membership Refund*

Locker Refund

Notes

Estimated difference in cost - when transferring to an activity with a higher/lower price

Identify if this cost is due or to be refunded

To calculate pre-paid membership refunds:

Enter the membership data on the bottom of this google sheet in rows 201-202. Matt Elkins built in the necessary calculations for these refunds.

Refund Needed?

Yes No

Date/Time

:

Unit Approval Request

Unit Employee Name*

First Name

Last Name

Unit Employee Email

Do you approve this cancellation/transfer request?*

Approved Not Approved, will detail reasoning below.

$25.00 processing fee*

Waived, no fee should be applied Yes, $25.00 fee applies

TOTAL Approved Refund Amount (if applicable) including fees*

Please enter pretax refund amount. Type N/A if no refund is offered

Approved Refund Amount: Club Sport Admin Fee

Approved Refund Amount: Club Sport Dues

Ideologic Transaction ID: Club Sport

Receipt Number: Intramurals*

Approved Refund Amount: Intramurals

Request Denied - Reasoning*

Please be detailed as this will help the Sales & Cashiers team respond to this customer.

For Private Instruction and multi-lesson packs, please identify dates of used instruction

Unit Manager Comments

Date/Time

:

Refund & Cancellation Completion

Sales & Service Staff Name

First Name

Last Name

Actions Completed

Online Payment within 6 months, cashnet refund processed Added to Employee PRD process Waiting to hear back from customer; left voicemail &/or sent email Credit card collected; Refund processed in office

Other:

Cashnet Confirmation #*

New Fusion Refund Order #

Select all closing tasks you completed. I verify that the above actions have been completed today.

Cashnet: Refund has been processed Emailed customer confirmation (CC unit approver) Fusion: Transfer complete Fusion: Membership End Dates Updated Fusion: Unenrolled from Program PRD membership/locker cancelled Refund denied

Other:

Notes

Date/Time

:

Cancellation Completion

Sales & Service Staff Name

First Name

Last Name

Additional notes here

Date/Time

: