JAMES MICHAEL CURLEY COMMUNITY CENTER
1663 COLUMBIA ROAD
SOUTH BOSTON, MA 02127

FOR FACILITY USE ONLY
Member #:________________
LC#:_____________________
Check#:__________________

PLEASE PRINT CLEARLY or your application may not be processed. CHECK or MONEY ORDER only.

Name:____________________________________________________ Date:________________________________
DO NOT FILL OUT THIS APPLICATION IF YOU ALREADY HAVE A CARD. BRING IN YOUR OLD CARD FOR RENEWAL.

Street Address:_______________________________________________________________________________________

City/State/Zip Code:_________________________________________________________________________________________

Phone:_________________________________ Male______ Female______ Date of Birth:____________________

Emergency Contact:________________________________Emergency Phone:______________________________

Email Address:____________________________________ We will attempt to notify members of any class and/or building closings.
Have you ever been a Member? (check one) Yes (card was lost)______ No______

James Michael Curley Community Center
Membership Form
PROOF OF CITY OF BOSTON RESIDENCY REQUIRED
Utility or drivers license accepted

Membership Types:
 Membership Fees:

Aerobic Membership
General Membership
Senior Membership (65+ years of age)
NON-CITY OF BOSTON RESIDENT FEE
Lost Card Replacement		 $120.00 (includes classes)
$100.00
$50.00 (includes classes)
additional $50.00 (any membership)
$10.00


The above-information is factual and complete to the best of my knowledge.

I, ____________________________________________, hereby waive and release any and all rights, causes of action, and claims for damages I may have against the City of Boston, Boston Centers for Youth & Families, and any and all other associated individuals or organizations, for any and all personal injuries or property damage resulting from my participation in Boston Centers for Youth and Families Programs.

MEMBERSHIP OFFICE located at K Street entrance: Mon 8 AM-4 PM, Tues-Fri 8AM-4 PM, Sat 8AM-4PM

No refunds after five (5) days from date of purchase.
Membership is non-transferable.
No one under the age of 16 allowed in wieght rooms, sauna and steam rooms.
No bags, coats or boots are allowed in weight rooms or class studios.
Lockers are available. Bring a lock. No articles are to be left overnight.
Do not leave valuables in lockers.
The facility is not responsible for lost or stolen items.
Work out at your own risk.
Respect staff and other members at all times. Harrassment and/or inappropriate behavior while using the facility will not be tolerated and may result in the termination of your membership.
If you have a concern please speak with a staff member or supervisor.

Member's Receipt

 

Name:___________________

Amount Paid:_____________

Date/Staff:_______________

 

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