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Member Information


Children (of member (s) to age 25 with I.D.) First

In Case of Emergency

Religious Affiliation (OPTIONAL):
Previous JCC member?
Did you tour the JCC?

Important Information – Please read carefully and check each box indicating your agreement.

I agree to abide by the rules and regulations of the Mid-Island Y JCC. The MIYJCC reserves the right to suspend or revoke membership privileges of the members whose behavior is deemed inappropriate or detrimental in any way to other members or staff. *
I hereby grant permission to the Mid-Island Y JCC to take photographs and makerecordings to be used in print or for promotional purposes. I understand and agree that Iam not entitled to receive any compensation for the above. *
I will carry my membership card with me when visiting the Center, I agree to pay a $5 replacement fee if the card is lost or damaged. *
Membership rates for programs are only valid if membership dues are paid through program completion. *
Members assume all risks involved in usage of the above facilities and the MIYJCC nor staff are not liable for any injury or harm that occurs on the premises. *


I am paying in full; I will receive a bill each year prior to my renewal date.
I agree to be charged in 12 monthly payments of on credit card I provided.
I understand that the 1st year of membership is for a 12 month period. I give the Mid-Island Y JCC permission to charge my credit card monthly until I cancel my membership in writing with 30 days written notice. Membership will be renewed automatically each year. I understand that the membership fees are subject to change and the JCC, at its discretion, may adjust the monthly rate, and charge my credit card applicable to my membership category.

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