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Schenectady JCC Membership Application

Adult 1:
First Name:
Last Name:
Gender:
Date of Birth:
Address:
City/State/Zip Code:
Home Phone:
Cell Phone:
Email Address:
Employer:
Occupation:
Business Phone:
Emergency Contact Name:
Relationship:
Emergency Contact Phone:
Jewish:
Yes
No
Synagogue:

Adult 2:
First Name:
Last Name:
Gender:
Date of Birth:
Home Phone:
Cell Phone:
Email Address:
Employer:
Occupation:
Business Phone:
Jewish:
Yes
No
Synagogue:

Child:
First Name:
Last Name (if different from family name):
Gender:
Birthdate:
Emergency Contact/Phone:
Relationship:

How did you hear about Schenectady JCC?
Friend
SJCC website
Other website
Internet Search
Doctor referral
Place of employment
Drive by/Live in the area
Newspaper/magazine
Yellow pages
Other

Did a SJCC member refer you to us?
No
Yes

Check your reason(s) for joining Schenectady JCC.
Pre-School
After School Care
Early Childhood Education
Summer Camp
Fitness Center
Group Fitness Classes
Indoor Cycling
Indoor Pool
Adult Sports Leagues
Youth Sports Leagues
JCC Maccabi Games
Silver SneakersTM
Senior Activities
Jewish Programs
Outdoor Pool & Tennis
Other