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Gym Reimbursement Requests- Due to HR by Wednesday, July 7th!

Posted on July 1, 2021


NOTE TO ADMIN. STAFF:  Please notify and/or post this notice for any employees in your department that may not have e-mail access – thanks!


It’s time to turn in your receipts for gym fees paid for July 2020 through June 2021.  Receipts are due no later than July 7, 2021.

You may submit requests by e-mail to or through interoffice mail to HR.  Be sure to include the attached Gym Reimbursement Request form.

The City of San Rafael reimburses employees up to $16.50 per month for personal gym memberships, personal recreation league fees or fitness-related rec facility fees.  Per the MOUs, this payment will be processed through payroll and is reported as taxable income.

*Please note:  Police Department employees are not eligible to participate in this program as they have their own reimbursement plan*

Follow these simple steps to request your reimbursement:

  1. Fill out the attached GYM REIMBURSEMENT REQUEST form.  All memberships must be in the employee’s name or clearly note the employee as an active member.
  2. Attach all backup documentation showing proof of payment.  You may submit bank account or credit card statements or a letter/statement from your gym.
  3. Make sure that any document you submit clearly states YOUR NAME and the DATES/MONTHS for which you paid.
  4. Each month should be clearly noted (please highlight, circle, underline, etc.) and marked PAID.

The maximum reimbursement allowable is $16.50/month.  Please note that annual memberships dues will be calculated and reimbursed based on a monthly amount (e.g., $100/yr is equal to $8.33/month).

Receipts should be submitted NO LATER than Wednesday, July 7th.

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