SJCC | Membership Registration

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