The Stamford JCC - Temple B’nai Chaim Membership Application

Join Our Community!

Complete this form and a member of our Membership Team will reach out to confirm your membership.

Membership Fees
Pricing effective thru June 18, 2026
Family (annually): $1,620
Couple (annually): $1,500
Senior Couple (annually): $1,080
Youth Individual • ages 13-26 (annually): $720
Individual Adult (annually): $1,020
Senior Individual Adult (annually): $720

Security Fee (annually): $500
Registration Fee (one-time): $100

Membership Type

Primary Contact First Name

Primary Contact Last Name

Phone Number

Please list the names of the family members that are joining your membership (if applicable).

B'nai Mitzvah Preferred Dates (if applicable)
for Family Memberships Only

Preferred B'nai mitzvah date: Option 1

Preferred B'nai mitzvah date: Option 2

Abide: I agree to abide by the policies, rules and regulations of Temple B’nai Chaim (TBC) and The Stamford Jewish Community Center (JCC), as amended from time to time by TBC and the JCC and to behave with appropriate conduct which would include but is not limited to damage or destruction of TBC or 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 TBC or JCC program, TBC, 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 TBC or 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 TBC or 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 TBC or 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 TBC stating this, along with a photo or photos of the individual(s) concerned.

Membership: Membership is for an initial 12-month period renewing on each anniversary date for a new 12-month term. Memberships to TBC being paid monthly will be charged a $100 early termination fee for cancelling after the initial term, and require written notice a minimum of 30 days before cancellation takes effect. There are no refunds for memberships paid in full. TBC 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, I agree to give TBC a minimum of 30 days written notice. Membership is not transferable or refundable.

Security Fee: In addition to membership, a non-refundable $500 per membership unit fee will be charged when membership is started.

Permission: I hereby give permission for my child(ren) to participate in all TBC and JCC activities. In the event that I cannot be reached, I hereby give permission to TBC or 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 TBC and 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 TBC, 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 TBC or JCC activity. I further agree to indemnify and hold TBC, 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 TBC membership or participation in any TBC or JCC activities.

Payment Information
Please select a payment method and fill out the corresponding section.

Payment Method

Payment Plan

Credit Card Information

Card Type

Name on Card

Credit Card Number

CVV

Expiration

I authorize TBC 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 TBC 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 TBC 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 TBC 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.

Temple B’nai Chaim Membership Application

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