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MJCC

The Mittleman Jewish Community Center is a proud beneficiary of the Jewish Federation of Greater Portland and is proud of our partnership with them in strengthening our local Jewish community and greater Portland community.

Event Registration Form

The MJCC is working towards providing our members and guests with an online registration system. As we prepare to get that functional, we have created this online form for your convenience in the interim and will update you when the new system is ready for use.

Please fill out this form completely and hit the submit button only once. Or if you prefer to fill out a hard copy of the form, please download the form here and drop it off at the front desk, or fax it back to 503.245.4233. Please call 503.244.0111 with any questions.

	Please enter your membership number (on your MJCC Membership card)

	Please enter the Participant(s) Name(s):*

	Please enter the Participant(s) street address(es):*

	Please enter your name if you are NOT the Participant.:

	Enter the main phone number of the person making this reservation:*

	Cell phone number:

	Please enter the main email address for the person making this reservation (we will send you an email confirmation).:*

	Please enter the Event Name:*

	Please enter the Event Code:*

	Number of Adults registering:

	How many Adults are members?

	Number of Children registering:

	How many Children are members?

	Net Fee:*

	Would you like to add a donation to MJCC Cultural programming to your total? If so, please enter the amount:

	Registration Total:

Use of any recreational facility and participation in any activity involves a risk of accidental injury despite all safety precautions. I/We have been informed of the activities to be conducted by the Mittleman Jewish Community Center (MJCC)and/or Portland Jewish Academy (PJA). I/We, as an individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and all liability, claims, costs, and damages including attorney fees and costs. I/We further agree to indemnify and hold harmless the Mittleman Jewish Community Center and Portland Jewish Academy, their officers, directors, independent contractors, volunteers, and all employees for any illness, injury or damage to me or my children, or my family members occurring during the use of any recreational facility or the participation in any activities conducted by the MJCC or Portland Jewish Academy. All fees must be paid in full at the time of registration. The MJCC reserves the right to cancel any activity based on insufficient enrollment. In the event that a program is canceled by the Center, all fees will be refunded within 30 days.

By choosing "Yes" below, I signify that I have read, understand, and agree to the statement above.*

	Yes
	No

Age Requirement: I agree that I will drop off my child(ren) no sooner than five minutes before event and pick them up no later than five minutes after the event ends. Children under the age of 13 MUST be accompanied by a parent/guardian at all times unless they are in a class.

Photo Release: By agreeing to the terms above, I give the Mittleman Jewish Community Center (MJCC) permission to use photographs and/or videos of myself or my child for publicity purposes, without any payment to me or my child whatsoever. I understand that such photographs and/or videos may be used on the MJCC web site and that children whose photos appear on the web site may be identified by first name only and sometimes will not be identified at all. if you do NOT wish photographs of you or your child to be used in publicity materials, please check the appropriate box below:*

	Yes, the MJCC may use our photos.
	No, the MJCC may NOT use our photos.

Cardholder’s Name:
Credit Card Type:
Card Number:
Expiration Date:

If you would like a copy of this submission, please put your email address in the field below.

Please Note: Questions marked with an asterisk (*) are required.