Curley Community Center ~ Membership Application

FOR FACILITY USE ONLY

Member #:________________________________
IC#: ___________________________
Check#:______________________________

Boston Centers for Youth & Families
Curley Community Center
1663 COLUMBIA ROAD
SOUTH BOSTON, MA 02127

PLEASE PRINT CLEARLY or your application cannot be processed.
CHECK or MONEY ORDER ONLY!

Memberships effective for one year from date of sign-up.
Do not fill out this application if you have an existing card.
Bring in your card for renewal.

Name:_____________________________

Date:_______________________

Street Address:________________________________________________

City/State/Zip:_________________________________________________

Date of Birth:________________

Phone #:______________________

Emergency Contact:_____________________________________________

Emergency Contact Phone #:______________________

Have you ever been a member?

Yes (lost card)___

No___

Circle One - Membership Fees:
$50.00 General (excludes classes)
$70.00 Aerobic
$10.00 Lost Card Replacement Fee

$5.00
$25.00

Senior (over 62)
Senior Aerobic (over 62)

Type of membership of lost card:

General

Aerobic

Membership Office Hours for pictures and cards - K Street:

Monday - Friday:

9:00-11:00 am

2:00-3:30 pm

6:30-8:30 pm

No bags, coats or boots allowed in any workout room. Lockers are available for use. Do not leave any items in lockers overnight. Bring a lock!

Do Not Leave Valuables In Lockers!
The facility is not responsible for lost or stolen items.

MEMBER RECEIPT

Name:___________________________
Amount Paid:_____________________
Date/Staff:______________________

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