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Program R.S.V.P.

Program Information

Program Name :  (Barcode : )
Date : 
Time : 
Location : 

Participant Information

Are you a MJCCA Member?  Yes  No
First Name : 
Last Name : 
Address : 
Please list the names of additional friends/family who will be attending : 
City, State, Zip : 
, 
Home Phone # : 
 (555-555-5555)
Cell Phone # : 
 (555-555-5555)
Alt Phone # : 
 (555-555-5555)
Email : 
Birthdate : 
 (MM/DD/YYYY)

Under 18 please fill in the information below : 

Gender : 
 Male  Female
Grade : 
Year graduating from high school : 
Name of school : 

Waiver

I HAVE READ THE MARCUS JEWISH COMMUNITY CENTER OF ATLANTA RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE, CONTINUING AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT OF THE LAW.


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