Locker Registration Form: Campus Rec: Adelphi University

To use the recreational locker rooms in Woodruff Hall for the 2006-07 academic year, please fill out the Locker Registration Form and return it to the Campus Recreation office, or submit an online application.

First Name
Last Name
Street Address Line 1
Street Address Line 2
City
State
Zip
Email Address
Daytime Phone #	(ex: 516-555-1234)
I am a Current Adelphi University	Resident Student Commuter Student Faculty/Staff/Administrator Alumni Leisure Passport Member Community Recreation Member Adult Fitness Program Member (ALP)
Locker Room	Women's Locker Room Men's Locker Room
Initial Request for locker
Locker Number
Locker Combination
Renewal
Locker Number
Locker Combination
Locker Change Request
Current Locker Number
Requested Locker Number
Locker Combination
I agree to adhere and abide by the following terms and conditions relative to the use of Adelphi University locker space: I understand that the storage of illegal and hazardous materials is prohibited. I understand that the locker is University property and may be inspected by the University if there is reasonable suspicion that the search will uncover evidence of a violation of law or Adelphi University Rules. I will provide my own lock to secure the locker and realize that contents of an unsecure locker are not the responsibility of Adelphi University Campus Recreation if lost or stolen. I understand that I must re-register my locker at the designated time which will be posted on signs and via e-mail, and I understand that all unregistered lockers are subject to having the lock and contents removed.

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