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JCC Service Desk
408.357.7429

Register - Adult

Register - Child


 

Registration Form - Child

Complete this form to register for a JCC program or class for your child...

Note: To register for a class using this online form, you must already have a credit card on file with the JCC. If you do not have a credit card on file with us, please print out the registration form and mail it or fax it. Click here for a printable registration form.

* Membership:  I am an APJCC member.
My membership number is...
Note: Your membership number is the number on your membership card that begins with the letter J.


 I am a non-member.
* Your First Name:
* Your Last Name:
Your Birth Date:
Your Gender: Male     Female
* Address Line 1:
Address Line 2:
* City:
* State:
* Zip:
* Home Phone:
Cell Phone:
Work Phone:
* Email:
* Child's First Name:
* Child's Last Name:
* Child's Birth Date:
* Child's Gender: Male     Female
* Grade in School:
Known Allergies:
* Name of Emergency Contact:
* Emergency Contact's Relationship to Child:
* Emergency Contact Phone #1:
Emergency Contact Phone #2:
Emergency Contact Phone #3:
* Do you authorize emergency medical treatment for your child? Yes     No
If you authorize emergency medical treatment, please provide us with your insurance carrier’s name and contact information, and your subscriber number and policy number.
 
Program Choices
You can use this form to register for up to five programs.
#1
* Program Title:
* Date & Time:
* Fee:
#2
Program Title:
Date & Time:
Fee:
#3
Program Title:
Date & Time:
Fee:
#4
Program Title:
Date & Time:
Fee:
#5
Program Title:
Date & Time:
Fee:
* Total Fees:
* Publicity Release: As the parent or guardian of the minor named above, I consent to photographs being taken of the minor and used in APJCC materials for marketing and fundraising purposes unless I otherwise indicate in writing. I understand there is no financial compensation for the photographs.
* Payment Info: I am a JCC member and you have my credit card on file. You have my permission to charge my credit card.


* = required field

    If Your Child's Class is Cancelled
    Classes must have a minimum number of participants in order to run. If a class does not meet its minimum enrollment, the class may be cancelled.

    Here is the policy that the JCC will follow if a class offered by the Early Childhood Education, Youth, or Teen departments is cancelled.

    • Two weeks before the class starts, if the class has not met its minimum enrollment, those who are already registered in the class will be contacted and asked if they can help recruit additional class participants (i.e., would your child like to bring a friend).

    • At least one week before the class starts, the JCC will contact everyone enrolled in the class to let them know the class has been cancelled.

    • If your child's class is cancelled by the JCC, you will receive a refund.

Payment Information...

  • If you are a Center Member and pay for your membership through automatic billing of your credit card each month, you have the option of paying online by selecting the "Charge my credit card on file" box above. If the JCC has your credit card on file for any other reason, you can also pay online. Make sure you've selected the "Charge my credit card on file" box above, and then press the "Submit Form" button below.

  • If the JCC does not have your credit card on file, or if you would prefer to mail your payment, click the "Print Form" button to print this form. Then mail it with your check made payable to “APJCC”. You can also deliver your check and completed form to the JCC Service Desk. If you would prefer to pay by credit card, click here to print an application form that includes a section for your credit card information.



    Mailing address:
    Addison-Penzak Jewish Community Center
    14855 Oka Road, Suite 201
    Los Gatos, CA 95032

    Questions about how to register for a class?
    Call the JCC Service Desk at 408.357.7429.