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JCA Membership Application

The Jewish Community Alliance is a membership organization. Its primary purpose is to provide programs through which Jewish identification and physical, social and emotional development of the individual may take place. JCA membership is open to all who understand and support its purposes.

Membership in Name of

Select
First Name
Middle Name
Last Name
Sex
Birthdate
Address
City
State
Zip code
Business Name
Occupation
Home Phone
Business Phone
Business Extension
Cellphone
Emergency Name
Emergency Phone
E-mail Address
Affiliation
Congregation Affiliation


Spouse

Select
First Name
Middle Name
Last Name
Sex
Birthdate
Business Name
Occupation
Business Phone
Business Extension
Cellphone
E-mail Address
Affiliation
Congregation Affiliation


Dependent children (23 years old & younger)

Name
Sex
Birthdate
E-mail Address
School
Name
Sex
Birthdate
E-mail Address
School
Additional Children

I/We are interested in (check all that apply):
 Fitness Program  Personal Training
 Group Exercise Classes  Water Aerobics
 Swim Lessons  Swim Team
 Recreational Swimming  Tennis Lessons
 Tennis Team  Recreational Tennis
 Fitness Equipment  Racquetball
 Adult Basketball  Youth Basketball
 Sports Clinics/Leagues  Summer Camps
 Aerobics Classes  Youth Camps
 Preschool/Kindergarten  Preschool Enrichment Classes
 Mommy & Me  AfterSchool Care
 Break Away Days (vacation care)  Youth Theatre
 Cultural Arts  Social Activities
 

I/We heard about the JCA through (check all that apply):

 Local Television  Local Radio
 Local Newspaper  JCA Mailer
 JCA Website  Social Media
 
Doctor
I was referred by
JCA Member
I was referred by

I/we are applying for membership at the JCA for use of its facilities, subject to the rules and regulations established for the JCA by its Board of Directors.

I/we have read and understand the following:

  • A registration fee is required for all those applying for membership. This fee is not applied to dues.
  • Membership is for a minimum of 12 months. Dues are to be either paid in full at the time of joining or extended payment plans may be arranged using automatic debit from checking accounts or automatic charges on your Visa or MasterCard. Membership will remain in effect unless I/we notify the JCA in writing with 30 days notice after the initial 12 months.
  • Membership fees are not transferable or refundable.
  • Membership services may be modified by the JCA.
  • Membership may be suspended or revoked if an individual does not comply with policies, rules and practices of JCA.
  • JCA reserves the right to raise dues as necessary.

    After we receive your online application, we will contact you to make an appointment for you to sign the application and make payment arrangements.

 

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move