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UCLA Recreation - Add-On Enrollment Application

Terms & Conditions

All Recreation memberships, locker rentals and fitness passes are non-refundable. For the most up-to-date policies, please review details on our Member Services page. All membership rates are subject to change.

Primary Recreation member must use this enrollment application for the following services:

  • Non-Payroll Deduction enrollments
    • Household Adult Membership
    • Family Membership
  • Payroll Deduction enrollments - for eligible UCLA employees only
    • Household Adult Membership
    • Family Membership
    • Locker Rentals 
    • In-person GroupX Fitness Pass 
    • BHIP Membership Enrollment

Primary Recreation Member Contact Information

Primary Member's UCLA Affiliation*
Are you currently enrolled in Payroll Deduction for Recreation membership?*
Note: ASUCLA employees, per diem, employees less than .5 FTE (50%), limited employees are not eligible for Payroll Deduction at this time; please select "No".
Primary Recreation Member Name*
If you do not know your ID, please type 'unknown'
Primary Recreation Member Address*
Please select desired membership upgrade:*
PAYROLL DEDUCTION: Locker Rental for Primary Member*
Locker rentals will be paid for via payroll deduction.
PAYROLL DEDUCTION: In-Person Group X Fitness Pass for Primary Member*
Group X Fitness Pass will be paid for via payroll deduction.
PAYROLL DEDUCTION: Please select desired membership upgrade:*
Membership will be paid for via payroll deduction.
PAYROLL DEDUCTION: Locker Rental for Household Adult*
Locker rentals will be paid for via payroll deduction.
PAYROLL DEDUCTION: BHIP Enrollment (which includes Rec Membership)
BHIP Membership will be paid for via payroll deduction .
Upgrade to Family Membership (Includes Household Adult)
PAYROLL DEDUCTION: Household Adult Only Application
Household adult memberships will be paid for via payroll deduction.

Household Adult Membership Application

Important:

  • Please ensure your household adult has created a Recreation account if they are a brand new Rec member.
  • Do NOT add your household adult as a 'dependent' in your Recreation profile
  • This section of this request form is NOT a Family Membership request, please review your selection above as needed.

Instructions to create or verify your Recreation account:

  • Go to: https://secure.recreation.ucla.edu 
    • 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. 

  • 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.
  • Household adult must be at least 18 years old. 

For most current pricing, review your affiliation on our Member Services page.

ENROLLMENT PROCESS 

  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 to the household adult via email to register themselves for the Recreation membership online. 

Please review all Recreation Policies



Household Adult Name *
Must have a Recreation account prior to submitting this form. Review top of form for details.
Household Adult Address*
Proof of Mailing Address for Household Adult (jpg, jpeg, pdf). Proof of the household adult's mailing address is required to upload to this form. Examples of proof: current lease agreement, utility bills, driver’s license, marriage domestic/partner certificate showing name and address. *
No File Chosen
File uploads may not work on some mobile devices.
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
Membership Policy: All information on this form is valid and accurate; memberships will be revoked upon false information. All Recreation memberships are not refundable, and extensions are not offered.*
Payroll Deduction Confirmation: All information on this form is valid and accurate; memberships will be revoked upon false information. I understand this membership automatically enrolls me in an ongoing Recreation members paid for via payroll deduction. Deductions will start January 1, 2023. *
Use your mouse or finger to draw your signature above

Locker Rental Policy Agreement

PAYROLL DEDUCTION - LOCKER RENTAL COMMITMENT

  • I understand this is a locker rental request utilizing payroll deduction.  
  • I understand discounts and refunds are not available for any locker rentals for any reason. 
  • I understand that lockers can only be assigned to those members with an active Recreation membership. Locker assignments are on a first come, first serve basis based on this form submission time and date. 
  • I understand the Sales & Service Team will review requests in the order they were submitted within 3-5 business days. If approved, the Sales & Service Team will assign you a locker based on availability.
  • I agree to the monthly payroll deductions to maintain my locker rental until I choose to cancel it.


Please review prior to purchase: LOCKER RENTAL POLICIES

Use your mouse or finger to draw your signature above
Please provide a USA phone number, as we are unable to contact international phone numbers
Please list Student ID, Employee ID, or Rec ID. Please type "unknown" if you need assistance finding this number.
Customer Mailing Address
Current UCLA Campus Affiliation

PAYROLL DEDUCTION: Locker Rental Request - Primary Member

Primary Member Name*
How many lockers are you (primary member) requesting in total? (i.e. if requesting 1 locker in JWC and 1 locker in SCRC, please select 2 lockers)*
IMPORTANT: 2nd and 3rd locker requests are not guaranteed. We will do our best to accommodate based on availability.
Requested Facility (Primary Member Request)*
Preferred Locker Room*
Locker Preference - JWC*
Locker Preference - SCRC*
Locker Preference - KREC (ONLY HALLWAY LOCKERS AVAILABLE)*
Locker Preference - SAC*

John Wooden Center Locker Room Map


JWC Locker Room for Women: https://recreation.ucla.edu/media/814

JWC Locker Room for Men: https://recreation.ucla.edu/media/813

PREFERENCE 1: John Wooden Center Zone - Woman*
https://recreation.ucla.edu/media/814
PREFERENCE 2: John Wooden Center Zone - Woman*
https://recreation.ucla.edu/media/814
PREFERENCE 1: John Wooden Center Zone - Man*
https://recreation.ucla.edu/media/813
PREFERENCE 2: John Wooden Center Zone - Man*
https://recreation.ucla.edu/media/813
PREFERENCE 1: KREC ZONE*
Limited availability
PREFERENCE 2: KREC ZONE*
Limited availability
I, the Primary Rec member, am committed to maintain a locker rental paying via payroll deduction. I understand I need to cancel by submitting the Recreation Cancellation form if I no longer want this locker rental to avoid rental fees. By acknowledging below, I am agreeing to all locker terms and policies. *

PAYROLL DEDUCTION: Locker Rental Request - Household Adult

Household Adult Name*
How many lockers is your Household Adult requesting in total? (i.e. if requesting 1 locker in JWC and 1 locker in SCRC, please select 2 lockers)*
IMPORTANT: 2nd and 3rd locker requests are not guaranteed. We will do our best to accommodate based on availability.
Requested Facility (Household Adult Request)*
Preferred Locker Room*
Locker Preference - JWC*
Locker Preference - SCRC*
Locker Preference - KREC ONLY HALLWAY LOCKERS ARE AVAILABLE*
Locker Preference - SAC*

John Wooden Center Locker Room Map


JWC Locker Room for Women: https://recreation.ucla.edu/media/814

JWC Locker Room for Men: https://recreation.ucla.edu/media/813

PREFERENCE 1: John Wooden Center Zone - Woman*
https://recreation.ucla.edu/media/814
PREFERENCE 2: John Wooden Center Zone - Woman*
https://recreation.ucla.edu/media/814
PREFERENCE 1: John Wooden Center Zone - Man*
https://recreation.ucla.edu/media/813
PREFERENCE 2: John Wooden Center Zone - Man*
https://recreation.ucla.edu/media/813
PREFERENCE 1: KREC ZONE - MENS AND WOMENS LOCKER ROOMS SOLD OUT*
Limited number of lockers available.
PREFERENCE 2: KREC ZONE - MENS AND WOMENS LOCKER ROOMS SOLD OUT*
Limited number of lockers available.
I , the Primary Rec member, am committed to maintain a locker rental for my Household Adult by paying via payroll deduction. I understand I need to cancel by submitting the Recreation Cancellation form if I no longer want this locker rental to avoid rental fees. By acknowledging below, I am agreeing to all locker terms and policies. *

Family Membership Request Form (Non-PRD)

FAMILY MEMBERSHIP includes up to 2 adults (18+ years) and 4 dependents (under 17 years).

ENROLLMENT PROCESS 

  1. Primary member submits this form on behalf of their family. Form is immediately routed to a Sales staff for review.
  2. If approved, detailed registration instructions will be provided to the Primary Rec member via email
  3. Primary member signs into Rec account and purchases online for the Family membership to activate access.

Please review all Recreation Policies prior to purchase.



Are you adding a Household Adult to your family membership?*
Household Adult Name*
Email will be used to create account username for login if this is a brand new Rec member.
Household Adult Preferred Gender*
How many youth dependents are you adding to your Family Membership?*
Dependent 1 Name*
Dependent 1 Preferred Gender*
Dependent 2 Name*
Dependent 2 Preferred Gender*
Dependent 3 Name *
Dependent 3 Preferred Gender*
Dependent 4 Name *
Dependent 4 Preferred Gender*
Membership Policy: All information on this form is valid and accurate; memberships will be revoked upon false information. All Recreation memberships are not refundable, and extensions are not offered.*
Use your mouse or finger to draw your signature above

Family Membership Request Form - Payroll Deduction

FAMILY MEMBERSHIP includes up to 2 adults (18+ years) and 4 dependents (under 17 years).

Ongoing Pricing - Payroll Deductions begin January 1, 2023. For most current pricing, review your affiliation on our Member Services page.

Payroll Deduction Enrollment Process

  1. Primary Rec member submits this request form on behalf of their family. Form is immediately routed to a Sales & Service Staff for review.
  2. If approved, detailed instructions will be provided to the Primary Rec member via email to register for the Family membership online.
  3. Primary member signs into Rec account and registers online for the Family membership to activate access.

Please review all Recreation Policies prior to purchase


Are you adding a Household Adult to your PRD Family Membership?*
Household Adult Name*
Email will be used to create account username for login if this is a brand new Rec member.
Household Adult Preferred Gender*
How many youth dependents are you adding to your Family Membership - PRD?*
Dependent 1 Name*
Dependent 1 Preferred Gender*
Dependent 2 Name*
Dependent 2 Preferred Gender*
Dependent 3 Name *
Dependent 3 Preferred Gender*
Dependent 4 Name *
Dependent 4 Preferred Gender*
Payroll Deduction Confirmation: All information on this form is valid and accurate; memberships will be revoked upon false information. I understand this membership automatically enrolls me in an ongoing Recreation membership paid via payroll deduction. Deductions will start the 1st of the following quarter. *
Use your mouse or finger to draw your signature above

Sales & Service: Completion

SALES TEAM - PROCESSING TASKS for HA applications – PRD and non PRD:

  1. Check if primary member has active membership
  2. Check if household adult has an account
  3. Link household adult profile to primary member in Fusion, if necessary.
  4. Verify and update matching mailing addresses - update Fusion profile as needed
  5. Add Household Adult Eligibility to household adult profile to match the primary Rec Member's eligibility in Fusion.
  1. Add Household Adult Membership to Fusion profile using "actions" and "point of sale" and “membership”.
    1. HA of Fall Extension students end date 1/3/2023
    2. HA of Employee/Retiree end date 6/30/2023
    3. HA of Undergrad/Grad end date: 1/3/2023
    4. HA of Alumni end date: 6/30/2023

SALES TEAM - PROCESSING TASKS for PRD locker rentals:

  • Assign locker on Fusion profile using "actions" and "point of sale" and “lockers”.
  • Make sure to set the END DATE of the locker to the following day. (Example: Today’s date is 10/28/22, set the end date of the locker to 10/29/22.)

SALES TEAM - PROCESSING TASKS for non PRD Family Membership:

  • Check if all adults and youth named on the application have an account that is attached to the adult.
  • Create accounts if needed, using the information from the application, and connect them to the adult’s profile.
  • If HA doesn’t have a profile, create the profile with the email provided and email them the username and temporary password.
  • Assign the correct family membership on the adult’s profile, using "actions" and "point of sale" and “membership”.
  • Family membership SINGLE (1 adult and up to 4 youth)
  • Family Membership DOUBLE (2 adults and up to 4 youth)
  • When prompted to select family members, select the adult and all youth that were named on the application.
  • Change the END DATE of the membership to the next day. (Example: Today’s date is 10/28/22, set the end date of the membership to 10/29/22.)
  • Complete checkout.
Sales & Service Representative*
NON PRD: HA Membership
non payroll deduction requests
NON PRD: Family Membership
PRD: Approved Add-On Enrollments
Date/Time
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