Online Membership Registration: Payroll Deduction
(Full Time University Faculty / Staff Only)
Deduction amounts below reflect the Faculty / Staff annual membership fee effective May 23, 2014 of $124.00 through August 31, 2014.

Applicant Name
Last Name:  First Name: 
Penn ID # (8 bolded digits on your PennCard): 
Applicant Status:  Faculty/Staff     Spouse/Dependent     Charter Member
Address:
Street:
City:
State:
Zip Code:
 
Work Telephone:
Home Telephone:
E-mail:
Gender:
Male Female
Primary Member's Name (if applicant is Spouse Dependent status, list primary member here)
Last Name: First Name: PennID

By paying for membership through payroll deduction you will continue to be charged unless a written cancellation request is submitted to the Department of Recreation. All cancellation are subject to a $25 fee. Contact membership services for cancellation information. Payroll Deduction cannot be used for Locker Service.

** Payroll deduction is only available to full-time Penn employees. Health System and CHOP employees are not eligible for payroll deduction. Please check below if you are paid weekly or monthly. Deductions for monthly employees will begin with the July 2014 paycheck. The monthly fee will be divided into 2 paychecks.

Faculty / Staff Pay Schedule: Weekly ($20.67) Monthly ($62.00)

A Summer Group Exercise Pass entitles you to unlimited group exercise class access. An additional $10.00 (weekly) or $30.00 (monthly) will be deducted. Note: you must physically pick up your Summer GroupX Pass from Membership Services.

Add Summer Group Exercise Pass (Additional $60) yes no


User Agreement/Waiver - By being permitted access to Recreational Facilities, users acknowledge their agreement to the following:
  1. Certain risks of injury are inherent to participation in sport and recreational activities. These types of injuries may be minor or serious and may result from one's own actions, and of others, or a combination of both.
  2. Posted or distributed rules and regulations are designed for the safety and protection of recreational users, who in turn are responsible to abide by these rules and regulations.
  3. Certain activities require a minimum level of health and fitness ability. Recreational users warrant being physically fit to participate in any activities undertaken, and understand a choice to participate brings with it the voluntary assumption of risks of injury, which may arise from participation in these activities.
  4. Recreational users agree that the University of Pennsylvania, its employees and agents shall not be liable for injury to person or loss or damages to personal property arising form, or in any way arising, or in any way resulting from the participation in these activities, unless such injury is caused by the sole negligence of the University, its employees or agents while acting within the scope of their duties, and agree to waive such claims against the University for such injury or loss.
Locker Agreement
  1. All lockers are the property of the University of Pennsylvania and the Department of Recreation. Lockers are to be used for legitimate recreational purposes. All locker users understand their responsibility in protecting the welfare of other users while renting a locker.
  2. Certain occasions require our staff to check lockers for unreturned towels, equipment and known safety/security issues, on these occasions users will be notified.
  3. Lockers will be cleared annually, notification and signage will be placed in the facilities.
  4. Lockers not cleared will have contents removed and articles kept for 30 days, after which they will be discarded or given to charity.
  5. To reclaim items a $40.00 fee will be assessed.
By checking this box, I acknowledge that I have read and understand the User Agreement/Waiver, Locker Agreement and Payroll Deduction Procedure.