Community Account - Levine Jewish Community Center, Charlotte, NC

PLEASE READ: If you are a Community Participant (program participant or guest) NEW to the Levine JCC, please ensure you fill out the Community Account Form before filling out a waiver.

If you are already in our computer system, there’s no need to complete another Community Account Form. You are likely in our system already if you have been a prior member, participated in programming or private lessons, or visited the Levine JCC in the past two years. If you are unsure, please call the Customer Service Center at 704-366-5007 for verification.

Step 1: General Information

Number of Adults

Number of Children ( Under the age of 26)

Number of Caregivers

Are you an Adult that needs a Caregiver?

Step 2: Account/Household Details

Account Name

Primary Phone

Account Formal Addressee

Informal Addressee

Billing Address

Address

Apt., Unit, Etc.

City

State

Zip

Home Address same as Billing Address

Home Address

Address

Apt., Unit, Etc.

City

State

Zip

Other Information

How did you hear about Levine JCC

Jewish Household

Have you (or your family members) been LJCC members in the past?

Have you taken a membership tour of the facility?

If yes, what was the approximate tour date:

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relation is Required

Referred By

Step 3: Individual Information

Step 4: Payment Information

Would you like to put a payment method on file for programming or purchase of commerce items (vouchers, apparel, etc.)? You will not be charged until you enroll in programming or make a commerce purchase.

Credit card information:

Card Type

Name on Card

Credit Card Number

CVV

Expires

eCheck information:

Bank ABA Code

Bank Name

Bank Account Name

Bank Account Number

I authorize the Sandra and Leon Levine Jewish Community Center (Levine JCC) to prepare and execute a bank draft or EFT in the amount and by the method indicated above. I authorize my banking institution to debit my account for the amount indicated. I understand and agree that if I close my account or stop payment on my bank draft or EFT that I will be obligated to pay the balance of my fees immediately. If for any reason my draft should not be honored, I will be responsible for that draft amount plus a $25 service charge. I understand that my account will be drafted on the 5th day of each month. I understand that the Levine JCC will notify me in advance of any change in the monthly fee charged to my account due to any change in fees for my membership or for new services added by my consent.

Confirm Authorization and save payment information to my account

Step 5: Review and Approve

Community Application: I, the undersigned, hereby make application for program participation or guest privileges at the LJCC. I agree to abide by its rules, by-laws and Code of Conduct. I attest that all information provided in this application is true and accurate. Permission is granted for photographs to be taken and used for future publicity.

Printed Name