LFJCC Member Application

Membership Application
Were you referred by another JCC Member

YesNo
Name of Referring Member
How did you hear about us?*

PostcardFacebook or InstagramInternet Search/Google AdEmailPrint AdFriend/Word of MouthTV or Radio
Promo Code
Have you been to the Lawrence Family JCC in the last year?

YesNo
Visitor ID (Found on your ID CARD)
MEMBER INFORMATION: PRIMARY MEMBER
Title

Mr.Mrs.MissMs.Dr.Rabbi
Member Name*

First NameMiddle NameLast Name
*
Date of Birth*

MonthDayYear
Date
Gender
Type in Response
Email*
example@example.com
Home Phone (Member)

Area CodePhone Number
Cell Phone (Member)*

Area CodePhone Number
Occupation (Member)
Employer (Member)
Emergency Contact*
ADDITIONAL MEMBER
Would you like to add an additional Member?*

YesNo
Additional Member Title

Mr.Mrs.MissMs.Dr.Rabbi
Additional Member*

First NameMiddle NameLast Name
*
Date of Birth*

MonthDayYear
Date
Gender
Fill in Response
Email (Additional Member)*
example@example.com
Home Phone (Additional Member)

Area CodePhone Number
Cell Phone (Additional Member)*

Area CodePhone Number
Occupation (Additional Member)
Employer (Additional Member)
Emergency Contact*
CHILDREN (Under 22 years old)
Would you like to add a child?

YesNo
How many children will you be adding?

1 Child2 Children3 Children4 Children
Child 1 Name

First NameLast Name
Child 1 Birthdate*

MonthDayYear
Date
Child 1 Gender
Type in Response
Child 2 Name

First NameLast Name
Child 2 Birthdate*

MonthDayYear
Date
Child 2 Gender
Type in Response
Child 3 Name

First NameLast Name
Child 3 Birthdate*

MonthDayYear
Date
Child 3 Gender
Type in Response
Child 4 Name

First NameLast Name
Child 4 Birthdate*

MonthDayYear
Date
Child 4 Gender
Type in Response
MEMBERSHIP WAIVERS SECTION

(TO BE COMPLETED BY PRIMARY MEMBER)
CODE OF CONDUCT
The Lawrence Family Jewish Community Centers of San Diego County, commonly known as The Lawrence Family Community Center, JACOBS FAMILY CAMPUS (LFJCC) is committed to providing a friendly and comfortable environment for all. Inappropriate conduct or language is not tolerated. Appropriate athletic wear, shirt and shoes are required at all times. Closed-toed shoes are required while using the athletic courts, participating in fitness training or classes, and inside the Fitness Center. As a courtesy to other members, please refrain from cell phone use within the Fitness Center. The LFJCC, through its CEO or delegate, reserves the right to remove from the premises any individual acting in an inappropriate manner and further reserves the right to cancel the membership of any such person without refund. Smoking and weapons of any kind are prohibited on the campus. (other than worn by law enforcement or security personnel)
Initials (Code of Conduct Policy)*

Clear
CANCELLATION POLICY
I/We acknowledge that memberships are billed monthly and
continues until notification of cancellation is received. If I/We wish
to terminate my/our membership, I/we must give 30-day written
notice prior to the first of the month, return all membership cards
and complete an exit survey and I/we understand that membership at
LFJCC is non-transferable or non-refundable. I/We acknoweldge that
all parties on the account must be in good financial standing to retain
membership.
Initials (Cancellation Policy)*

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GUIDELINES FOR LFJCC MEMBERSHIPS WITH YOUNG CHILDREN

Jacobs Fitness Center
- Members under the age of 15 are not allowed in the Fitness Center
  except under the following conditions:
  - Teens ages 13-14 must complete certification in order to use
    LFJCC Fitness Center.
Friedenberg Olympic Pool:
- Children under the age of 13 must be accompanied by
  a parent or guardian.
- Children under the age of 13 are not permitted in the spa.
For general information and rules please visit lfjcc.org.
GUIDELINES FOR LFJCC MEMBERSHIPS WITH YOUNG CHILDREN

Jacobs Fitness Center
- Members under the age of 15 are not allowed in the Fitness Center
  except under the following conditions:
  - Teens ages 13-14 must complete certification in order to use
    LFJCC Fitness Center.
For general information and rules please visit www.lfjcc.org.
Initials (Guidelines for Memberships with Young Children)*

Clear
GUEST PASSES AND GUEST POLICY
Guests of members are welcome at the LFJCC and must be
accompanied by a member. Guest passes are electronically tracked
on your membership account, and guests are required to check in
with guest services to complete a guest form. Each membership
receives 1 complimentary guest pass per month, after which
additional guest passes may be purchased at the daily rate of $15 for guests who are 15 or older.
Initials (Guest Passes and Guest Policy)*

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MEMBERSHIP CARDS
Membership cards are issued to each member aged 15 and over
and are required to access the facility. Teens aged 13-14 must be accompanied by a parent in order to be issued a membership card and use the LFJCC Fitness Center. All members are required to show their badge upon entering the center. If for any reason the membership card is not presented upon check-in, an ID and verification of current membership is required. Any LFJCC staff member may ask for proof of membership at any time while you are in the center. Replacement membership cards may be obtained from the Guest Services desk for $10.
Initials (Membership Card Policy)*

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LOCKER ROOMS
Lockers are available for daily use in both the men’s and women’s
locker rooms at no charge. Children over 4 years of age may not be in
a locker room designated for the opposite sex. For your convenience,
please use our family locker room. Please check with a Guest Services
or Fitness Representative for more information.
Initials (Locker Rooms Policy)*

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FACILITY HOURS

Monday - Thursday 6:00 am - 9:00pm | Friday - Sunday 6:00 am-6:00 pm

Hours are subject to change. Please visit our website for holiday hours, www.lfjcc.org.
Initials (Facility Hours) *

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PHOTO AND SOCIAL MEDIA RELEASE
I/We give my permission to the LFJCC to use photographs/videos in promotional materials including social media, the LFJCC website and any other form of communication, trade, and for any other lawful purpose whatsoever that are taken while participating in JCC programs without the opportunity to approve or review the finished product that may be used in connection therewith or the use to which it may be applied.
Initials (Photo and Social Media Release)

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ARBITRATION AGREEMENT
I/We understand that participation in physical conditioning and
recreational programs is at my/our own and/or my/our family’s own risk. All
disputes that may arise out of this relationship, including but not
limited to whether based on tort, contract, statute, equitable law or
otherwise, shall be submitted in binding arbitration.
Initials (Arbitration Agreement)*

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WAIVER, RELEASE
I/we understand that a certain document entitled “LFJCC Member Waiver, Release and Indemnification of All Claims, and Assumption of Risks” will be provided to us and must be completed and signed by us in order to complete this registration process.
Initials ( Waiver, Release)*

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ADDENDUMS
I/we understand that any document entitled “Addendum to Membership Application” which is concurrently or subsequently signed by me/us shall be considered part of and added to this Membership Application.
Date

MonthDayYear
Date
Date: {date}
Primary Member Name

First NameLast Name
Signature*

Clear
CHOOSE YOUR MEMBERSHIP
TYPES OF MEMBERSHIPS**

Teen/Young Adult** - Ages 13-30 - $42/mo + $70 Registration FeeIndividual - Ages 31-64 - $68/mo + $130 Registration FeeCouple - Two adults same household - $128/mo + $130 Registration FeeFamily I** - One adult & children under 22 - $80/mo + $130 Registration FeeFamily II** - Two adults & children under 22 - $138/mo + $130 Registration FeeSenior Individual - Ages 65 and older - $42/mo + $70 Registration FeeSenior Couple - $80/mo + $130 Registration FeeCorporate - $4,860/year - minimum purchase of five membership units
** Ages 13-14 must complete a fitness orientation prior to using the fitness. center.

Membership rates are subject to change.
I am interested in applying Financial Assistance

YesNo
I am interested in applying Financial Assistance*

YesNo
Click here to complete our online application for financial assistance
CONTRIBUTING MEMBERSHIPS

Contributing Membership gives you all the benefits of joining the J and the opportunity to support the organization as a whole. A portion of your membership is tax deductible.
Contributing Member Rates

Shalom A - $5,000 (fair market value $2,812) - One Family II Membership - Program Credit $1,300Shalom B - $5,000 (fair market value $2,188) - One Family I Membership - Program Credit $1,300Double Chai A - $3,600 (fair market valued $2,512) - One Family II Membership - Program Credit $1,000Double Chai B - $3,600 (fair market valued $1,188) - One Family I Membership - Program Credit $1,000Chai A - $1,800 (fair market value $1,712) - One Family II Membership - Program Credit $200Chai B - $1,800 (fair market value $1,088) - One Family I Membership - Program Credit $200Mitzvah A - $1,600 (fair market valued $1,512) - One Family II Membership, Program Credit $100Mitzvah B - $1,600 (fair market valued $888) - One Family I Membership, Program Credit $100
Program credits can be used for classes, lessons, leagues or JCC Staff Personal Trainers. Excluded from program credits is the Nierman Preschool.
Should be Empty:

Membership Application

MEMBER INFORMATION: PRIMARY MEMBER

ADDITIONAL MEMBER

CHILDREN (Under 22 years old)

MEMBERSHIP WAIVERS SECTION

CHOOSE YOUR MEMBERSHIP

CONTRIBUTING MEMBERSHIPS