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Staff Benefits

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Staff Benefits and Wellbeing

Cancellation Form -Scarborough Hospital Onsite Gym

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First 5 digits on the back of your Trust ID Badge*

Please choose one of the following*

Full Name*

Email Address*

Assignment Number*


Mobile Number*

Are you a member of our Scarborough Gym Whats App Group*

Payroll Cancellation

By ticking this box, I authorise York & Scarborough Teaching Hospital NHS Foundation Trust to cancel the following deduction amount from my salary each month from the next available salary*

Total deductions *

Reason for Cancellation

Please choose one of the following*


I confirm I have read and are in agreement with the below declaration.*

Email 2*:

* required fields

Please read the following before submitting the above cancellation form:

• I understand that once I have submitted this form I will no longer be able to use the onsite gym and squash court.
• I understand that once I have submitted this form all additional memberships will be cancelled and I will inform my additional members that they are no longer permitted to use the gym.
• I understand that the Staff Benefits Team will instruct the payroll department to cancel my monthly deductions (if paying through salary)
• I understand that the Staff Benefits Team will instruct the security team to cancel my swipe access for the gym
• I understand that it is my responsibility to cancel the standing order (if paying by standing order)

Please note this form must be with the Staff Benefits Team by the 1st of every month in order to give enough time for processing with the payroll team before payroll cut off. Any forms received after the 1st of the month may not be processed in time and may incur a charge.

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