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Household Adult Membership Enrollment Request

Please ensure your household adult has created a Recreation account if they are a brand new member.  Instructions to create or verify your Recreation account:

  • Go to: 
    • Returning Recreation members: Click “Log In” in the upper right corner to update profile information
    • Brand new members: Click "Log In" and then "Sign Up" 

The primary member submitting this form must have an active Recreation membership to request a membership for one household adult. Household adult must be at least 18 years old.  Youth/minor dependents are not eligible for a membership at this time. 

  • Proof of the household adult's mailing address is required. Examples of proof: current lease agreement, utility bills, driver’s license, marriage domestic/partner certificate showing name and address. 
  • Please remove or hide all sensitive data including account information on the image prior to submitting.

In order to mitigate the risks of COVID-19 to our UCLA community, AT EACH VISIT TO FACILITIES each Recreation member will be required to provide either:

1. Proof of full vaccination, i.e. at least two weeks have passed since the member received the second dose in a two dose series, or at least two weeks have passed since the member received a single dose vaccine

2. Show a negative COVID-19 test (PCR or antigen) result within the 72 hours prior to that visit.

Primary Member's UCLA Affiliation*

Primary Member: Contact Information

Primary Member Name*
Primary Member Address*

Household Adult - Contact Information

Household Adult Name*
Must have a Recreation account prior to submitting this form. Review top of form for details.
Household Adult Address*
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Please remove or hide any account and sensitive information on the uploaded image as UCLA Recreation is not responsible for the storage of any sensitive data

Recreation Membership Services


Household Adult of currently enrolled UCLA Students: $60/quarter

Household Adult of UCLA Staff & Faculty, Emeriti/Retiree: $90/quarter


  1. Primary Rec member submits this form on behalf of their household adult.  Form is immediately routed to a Sales staff for review.
  2. If approved, detailed instructions will be provided for the household adult to register themselves for the Recreation membership online.
  3. Once the household adult is registered for the Recreation membership, they must verify their vaccination card at a drop in Zoom sessions (details will be provided via email).  
  4. Prior to coming to campus, each individual must complete the required UCLA Covid-19 Symptom Monitoring Survey and present upon each visit.  
Membership Policy: All information on this form is valid and accurate; memberships will be revoked upon false information. I understand that this quarterly Recreation membership gives my household adult access to facilities and priority Bookings. Bookings are required for certain zones/areas. Bookings are based on availability and not guaranteed. Pool bookings are the most impacted due to low capacities, and are difficult to secure. This Recreation membership for Winter quarter expires on March 25, 2022. This membership is not refundable and extensions are not offered.*
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Sales & Service: Completion

Sales & Service Representative*


  1. Verify and update matching mailing addresses - update Fusion profile as needed
  2. Link household adult profile to primary member in Fusion
  3. Add Household Adult Eligibility to household adult profile to match primary Rec member in Fusion
  4. Add Household Adult Membership to Fusion profile 
    1. Winter Extension students end date 3/1/22
    2. Employee/Retiree/Undergrad/Grad end date: 6/30/22
Membership Status*
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