The Stamford JCC - Membership Application

If you have previously held a Stamford JCC membership or you have participated in programs without membership, please click here for a streamlined application process.

Step 1: Account/Household Information

Membership Type

Children ( Under the age of 22)

Do you wish to add a Live-In Caregiver for $35 per month?

Executive Locker Information

Individual XLR Locker - $45.00 per locker / Couples XLR Lockers - $65.00

Do you wish to add an Executive Locker?

XLR Locker #1 (Ages 18+)

XLR Locker #2 (Ages 18+)

Step 2: Account/Household Details

Account Name

Primary Phone

Account Formal Addressee (Billing will be sent to this Name)

Informal Addressee

Billing Address

Address

Apt., Unit, Etc.

City

State

Zip

Home Address same as Billing Address

Home Address

Address

Apt., Unit, Etc.

City

State

Zip

Other Information

Religion (Optional)

Congregation Affiliation

Interests

The Center for Health & Wellness

Julius B. Kuriansky Fitness Center Group Exercise Classes Personal Training Youth Aquatics Adult Aquatics Youth Sports - Recreation Adult Sports - Recreation

The Vogel Family Center for Early Learning

KinderPlace: Full-Day Childcare JCC Sara Walker Nursery School JumpStart: Special Needs Program for 2-Year-Olds

The Selkowitz Center for Youth & Family

KidsPlace: After School Care Day Camps@The J Family Events

Programs & Classes

STEAM Classes Performing Arts Aquatics Teen Programs Inclusion Programs Adult and Active Adult Programs Senior Programs Arts & Culture Israel - Judaic Programs JCARES Volunteering Performing Arts Summer Programs Stamford J Basketball Summer Clinic

Other Interests?

Recently Moved From

I/We heard about the JCC through

Community Usage Friend Internet Search JCC Member JCC Former Member JCC Staff Live Nearby/Drive By Realtor Social Media Website Other

JCC Member (Name)

JCC Former Member Referral (Name)

JCC Former Member Referral (When)

JCC Former Member Referral (Where)

Friend/Family (Name)

REALTOR® (Name/Agency)

I/We were referred another way (Explain)

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relation

Step 3: Individual Information

Step 4: Billing Information

Payment Method

Credit card information:

Card Type

Name on Card

Credit Card Number

CVV

Expires

I authorize the Stamford JCC to initiate transactions to my credit card account and by the method indicated above. I authorize the credit card institution to charge my account, for the amount indicated, on the 1st day of each month. I understand that the JCC will notify me, in advance, of any change in the monthly fee charged to my account due to any change in the fees for my membership or for new services added by my consent.

eCheck information:

Bank ABA Code

Bank Name

Bank Account Name

Bank Account Number

I authorize the Stamford JCC to prepare and execute a bank draft or EFT in the amount and by the method indicated above. I authorize my banking institution to debit my account for the amount indicated. I understand and agree that if I close my account or stop payment on my bank draft or EFT that I will be obligated to pay the balance of my fees immediately. If for any reason my draft should not be honored, I will be responsible for that draft amount plus a $25 service charge. I understand that my account will be drafted on the 5th day of each month. I understand that the Stamford JCC will notify me in advance of any change in the monthly fee charged to my account due to any change in fees for my membership or for new services added by my consent.

Confirm Authorization and save payment information to my account

Recurring Total:
Total Due Today:

You will not be charged until your application has been processed.

Step 5: Review and Approve

Preferred Payment Option

Monthly Annually

Membership
Caregiver		$30.00
Locker(s)
Discount
Estimated Recurring
Join Fees
	Join Fees Total:
Estimated Price to Join

IMPORTANT INFORMATION: Please read carefully and check the box indicating your understanding.

Abide: I agree to abide by the policies, rules and regulations of the Center, as amended from time to time by the JCC and to behave with appropriate conduct which would include but is not limited to damage or destruction of JCC property, theft, follow proper safety precautions and practices, appropriate behavior, no fighting, no harassment (including physical and verbal abuse) of other participants and staff

CEO: The CEO, at his/her discretion, may suspend, cancel or revoke a membership at any time for any reason.

I hereby grant, by participating in a Stamford Jewish Community Center (the “JCC”) program, the JCC and its legal representatives the irrevocable right and unrestricted permission to use and publish photographs or video images of me and/or my children, or in which we may be included, for any purpose authorized by the JCC, including but not limited to: website use, social media, editorial publications, catalog and advertising use. This grant includes the right to modify and retouch the images in the discretion of the JCC. I understand that the circulation of such materials could be worldwide and that there will be no compensation to me for this use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products or the advertising copy or the printed matter that may be used in connection therewith. In granting this permission to the JCC and its legal representatives, I am fully and without limitation releasing it from any liability that may arise from the use of the images. I understand that if I do NOT want my name or image, or that of my child or family member, to be published I must submit a written letter to the JCC stating this, along with a photo or photos of the individual(s) concerned.

Membership: Membership is for an initial 12 month period. Memberships to the JCC being paid monthly will be charged a $100 early termination fee for cancelling within the first 12 months, and require written notice a minimum of 30 days before cancellation takes effect. Registrations that received pricing at the member rate will be charged the prorated difference in price between the member and community rate. There are no refunds for memberships paid in full. The JCC may adjust the monthly rates no more than once in any 12 month period.

Terminate: If I wish to terminate after a minimum of 12 months, or change my membership in any way, I agree to give the JCC a minimum of 30 days written notice. Membership is not transferable or refundable.

Secure Entry: I will use the OpenPath mobile app to gain secure entry to the JCC or will carry my OpenPath key fob with me when visiting the Center. I agree to pay a $10 replacement fee if my OpenPath key fob is lost or damaged.

Permission: I hereby give permission for my child(ren) to participate in all JCC activities. In the event that I cannot be reached, I hereby give permission to the JCC to act on my behalf to have medical treatment administrated to my child(ren) in the event of an emergency. I understand that I will be fully and directly responsible for the cost of medical attention.

I agree N/A I do not have children participating

Risk: In consideration of being permitted to participate in JCC activities and to use the facilities and equipment, I accept all risks to my (and my family’s) health including but not limited to risk of injury or death, that my result from such participation, and I hereby release the JCC, its Board of Directors, officers, employees and representatives from any and all liability for any and all claims and causes for action from loss or damage to me and/or my family’s property and for any and all injury to my person (or to my family member), including death that may result from or occur during participation in a JCC activity. I further agree to indemnify and hold the JCC its Board of Directors, officers, employees and representatives harmless from liability for the injury or death of any person(s) and damage to property that may result from my (or my family’s) negligence, intentional acts or omissions, arising from my JCC membership or participation in any JCC activities.

Signature
Clear

Individual Type

Religion

What's your Interfaith Religion?

Prefix

First Name

Last Name

Nickname

Legal Name

Suffix

My child does not have an Email

Mobile Phone

Gender Identity

Birthdate

Would you like to add an Executive Locker? (Ages 18+)

Address Same as Account

Address

Apt., Unit, Etc.

City

State

Zip

Employer

Occupation

Employer Address

Employer Address 2

Employer City

Employer State

Employer Zip Code

Employer Country

Does your employer match donations

Membership Application

Step 1: Account/Household Information

Executive Locker Information

Step 2: Account/Household Details

Billing Address

Home Address

Other Information

Interests

Emergency Contact Information

Step 3: Individual Information

Step 4: Billing Information

Recurring Total: Total Due Today:

Step 5: Review and Approve

Estimated Price to Join

IMPORTANT INFORMATION: Please read carefully and check the box indicating your understanding.

Shopping Cart

Recurring Total:
Total Due Today: