Membership Status:*
Member Non-Member Non-Member Affiliate
Please enter your non-member affiliate organization. Non-member affiliates include Charles E. Smith Jewish Day School families; Melvin J. Berman Hebrew Academy families; and members of synagogues who have joined the JCC’s Ulpan program. Please contact the registrar at 301-348-3855 if you have any questions.
Please note that the status selected here will be compared to our membership records and program fees will be charged accordingly.
PRIMARY MEMBER INFORMATION
Primary Member First name:*
Primary Member Last name:*
Address line 1:*
Address line 2:
City:*
State:*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
Zip:*
Home Phone:*
Cell Phone:*
Work Phone:
Email:*
Have you moved in the last 2 years?*
No
Yes If yes, previous address:
Notes:
REGISTRANT INFORMATION
Registrant First Name:*
Registrant Last Name:*
Registrant Date of Birth:*
Select a Month
January
February
March
April
May
June
July
August
September
October
November
December
,
Select Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
(i.e. 1996)
School Grade:
School Currently Attending:
Email Address:
EMERGENCY CONTACT INFORMATION
Registrants 18 years and under require two (2) emergency contacts. Registrants over 18 years require one (1) emergency contact.
PROGRAMS
After you enter each class code, please hit the tab key to view the class description and cost.
If you wish to register for a class without a recognized class code, please contact the JCC.
Class Code
Class Description
Fee
$
$
$
$
$
Subtotal :
$
Help us share the JCC with others! Donate a tax-deductible gift now .
$
TOTAL:
$
I agree to the following program registration agreement.
I understand that participation in JCCGW classes may involve physical or other activity that could result in injury. I (or my registered child) use the JCCGW at my own risk and hereby, for myself, my heirs, executors and administrators waive any and all rights and claims of any kind that I may have against the JCCGW as well as with employees, invitees, and agents of the aforesaid for any and all damages, and injuries, whatsoever, which I (or my registered child) may suffer or incur in connection with my attendance, participation, or membership in the JCCGW or in connection with my use of the facilities or programs of the JCCGW. I agree to maintain an “emergency contact card” on file for my registered child at the JCCGW. I also give permission for treatment of illness or injury sustained while participating in a JCCGW program or classes.
PAYMENT OPTIONS
Please note that the membership status selected above will be compared to our membership records and program fees will be charged accordingly. All charges are made over secure pages.
Type of card:*
Visa
Mastercard
American Express
Discover
Full Name (as written on the card):*
Card Number:*
Expiration:*
Month:*
01
02
03
04
05
06
07
08
09
10
11
12
Year:*
2008
2009
2010
2011
2012
2013
2014
2015
Three/Four digit security number *
Please be aware that photos of JCC program participants may be used in promotional materials, public relations efforts and/or videos. Please e-mail Rebecca Hurowitz at rhurowitz@jccgw.org to withhold your permission to use your image.
