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Cornell University

Recreational Services

Preferred way for us to contact you if needed (check one)
Status (check one)
Membership Types (check one)
$175, prorated and runs from date of purchase through June 30 of fiscal year
$75, runs 4 months from date of purchase (can only be paid by credit card or check)
This option is only available to the Cornell benefits eligible employee who has Aetna CPHL health insurance
Membership Payment Options (check one)
No charge to you. Membership fee is reimbursed up front through your Aetna CPHL insurance plan. This option is only available to the Cornell employee who has Aetna CPHL health insurance; spouses/partners not eligible for this.
Available to Cornell employees only; spouses/partners not eligible. Only available on 1-Year Wellness Recreation Membership type. By submitting this membership application I voluntarily request that Cornell deduct the membership fee from my wages throughout my continued membership.
Available to Cornell employees only; spouses/partners not eligible. Only available on 1-Year Wellness Recreation Membership type. By submitting this membership application I voluntarily request that Cornell deduct the membership fee from my wages throughout my continued membership.
Email wellness@cornell.edu or call (607) 255-5133 to make arrangements to remit payment by credit card/check; or stop by the Wellness Administrative office, room 305 Helen Newman Hall, M-F 9am-2pm, 3pm-5pm to remit payment.
I am requesting a scholarship application form be emailed to me. I will submit this form to cover up to 100% off of the membership fee. I understand that I will be contacted if there is any outstanding membership fee still due after the scholarship application form is processed.
Optional Free Wellness Individual Consultations (check all interested in)
Membership Policies, Waiver, Assumption Of Risk, and Informed Consent
Membership Policies: • Employees using payroll deduction or paying by check or credit card for 1-Year Wellness Recreation Memberships will be rolled into a fiscal year membership running from July 1 through June 30. Payroll deduction will automatically spread out payments that add up to the yearly goal amount according to the individuals pay schedule. Payroll deduction payments will be taken out 24 or 26 times throughout the fiscal year depending on your pay cycle. • All members will have the opportunity to cancel their 1-Year Wellness Recreation Memberships paid through payroll deduction or their CPHL Wellness Recreation Memberships prior to the July 1 automatic yearly membership renewal. This cancellation period typically takes place June 1 through June 30. • 1-Year Wellness Recreation Memberships are non refundable unless the member leaves the University or submits a doctor's note. Lack of participation does not eliminate this responsibility. In some instances we may reimburse a member who leaves the University or is unable to participate because of a medical reason. In these situations members will only be reimbursed for the remaining time on the membership and only from the time we are made aware of the situation. Other circumstances that require cancellation must be approved by the Cornell Wellness director, and will be subject to a $30 cancellation fee. • All members agree to the policies and procedures of both the Cornell Fitness Centers and Cornell Wellness. Cornell Wellness reserves the right to revoke membership at any time. In this case, unused membership fees will be refunded. • All membership types are available to employees based on primary status assigned by the Registrar's office (employee vs. student) as indicated on the Cornell ID card. Employees who are enrolled in the EDP and taking classes still have a primary designation as staff/faculty on their ID card, and therefore are eligible to purchase Wellness Memberships but are not eligible to purchase CFC student memberships. Students whose primary designation at the Registrar's office is as a student (even if working part-time as an employee) and whose ID card says student, are not eligible to purchase any type of Wellness Memberships. • Live streaming of on-campus in-person classes may occur. • If you have any questions about your membership or a special circumstance, contact wellness@cornell.edu. GINA Waiver: • The Genetic Information Nondiscrimination act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of employees or their family members. However, an exception is made when an employer offers health or genetic services to an employee, such as a wellness program, and the employee voluntarily discloses genetic information after providing a compliant written authorization. In order to comply with this law, we are asking that you confirm by signing below that any genetic information about yourself or medical information related to your family history you provide in a Cornell wellness program is knowingly and voluntarily provided for purposes of the wellness program. I understand that information I provide to the Wellness program will be used only by the Wellness Program and will not be shared with any other Cornell entity. COVID- 19 Assumption of Risk, Waiver, and Release of Liability: • I understand and acknowledge that COVID-19 is a global pandemic and a public health risk. I understand that the risk of becoming exposed to or infected by COVID-19 at Cornell University may arise from the actions, omissions, or negligence of myself and/or others. I recognize that the Cornell cannot limit all potential sources of COVID-19 infection. I knowingly and voluntarily assume all risks, including but not limited to, the risk of illness, death, bodily injury, disability, or exposure or infection with COVID-19, for myself, and my family. I fully understand the risks, I knowingly and voluntarily waive and release Cornell University trustees, officers, agents, volunteers, employees, and students (the “Released Parties”) from all present and future claims of any type, including negligence, for any harm or loss, including but not limited to, economic loss, personal injury, disease, death or property damage suffered by me or my family, as a result of my participation in a Cornell University program, camp, or activity or as a result of my presence on Cornell University’s campus (the “Activities”). I agree to indemnify, hold harmless, and covenant not to sue the Released Parties for any personal injury, death, medical expenses, disability, loss of capacity, property damage, court costs, attorney’s fees, or other loss arising out of the Activities. Informed Consent: • I understand that Cornell University makes no assurances, implied or otherwise, that the program will completely or accurately assess my health status, as this field is not always an exact science. In addition, I agree on behalf of myself, my assigns, executors, and heirs, to release, hold harmless, and indemnify Cornell University, its Trustees, Officers, Agents, and employees from any and all liability, damage, claim or loss of any nature whatsoever arising out of or in any way related to my Recreation Membership participation except those things due to the sole and active negligence of Cornell University.
Sign above
By signing and dating above, I agree to the terms of the Membership Policies, Waiver, Assumption Of Risk, and Informed Consent listed above for the duration of my Wellness Recreation Membership.