FairfaxNCS - New Customer

Once you have created an account, you will be able to use the NCS RECDynamics system.

General Information

First Name

Middle Initial

Last Name

Phone

Email Address

Confirm Email Address

Has Special Needs

Birth Date (mm/dd/yyyy)

Gender

Ethnicity

Address

Search Address

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Country

Address (Line 1)

Address (Line 2)

City

State

Postal Code/Zip

Other

Name of School

Primary Language

Preferred Center

Marketing (Yes/No)

Additional Email

Add Emergency Contacts

First Name

Last Name

Primary Phone (XXX-XXX-XXXX)

Secondary Phone (XXX-XXX-XXXX)

Senior Center Membership Request

(*)

Select Preferred Center :

Memberships to Senior Centers are open to persons 50 years of age and who meet eligibility requirements and who have paid their annual membership dues to the Fairfax County Department of Neighborhood and Community Services (NCS) Senior Centers. Participants have access to all Fairfax County Senior Centers and can participate in community programs sponsored by NCS. Memberships are non-transferrable. Membership fees for Fairfax County Residents range from $24 to $48 annually based on household income with Proof of Income. Non-County residents may purchase a membership for $100 per year.

The following sites are NCS Senior Centers: Bailey’s Senior Center, Herndon Senior Center, Hollin Hall Senior Center, James Lee Senior Center, Kingstowne Center for Active Adults, Lewinsville Senior Center, Lincolnia Senior Center, Little River Glen Senior Center, Lorton Senior Center, Pimmit Hills Senior Center, Providence Senior Center, South County Senior Center, Sully Senior Center and Wakefield Senior Center.

(If you do not wish to obtain a paid senior center membership, please skip the section below (Preferred Senior Center & Eligibility Acknowledgement). Please continue on to the REGISTRATION AGREEMENT section of the application. The NCS General Membership is a free membership which will allow you access to attend programs at a local Community Center.

Eligibility: To qualify for membership at Neighborhood & Community Services (NCS) Senior Centers, a participant must be 50 years of age or older and with minimal support to be:

• Able to orient correctly to person, place and time
• Able to independently navigate to programs and through center facilities safely
• Able to receive, follow and respond appropriately to instructions and emergency directives independently.
• Able to maintain personal care (eating, restroom usage, personal hygiene, medication management) independently
• Able and willing to follow the Code of Conduct

I have read, and understand the Senior Center Membership Eligibility If I no longer meet one or more of the Eligibility Requirements, an evaluation by trained staff will be utilized to determine my functional level and appropriateness of my continued participation. NCS will assist and refer prospective and current members to appropriate resources and transition them to other supportive services in their best interest and safety.

Registration Agreement

(*)

I have read and understand the

participation approvals and agreements.

Parent Participant Authorization: I hereby grant permission to my child participant/registrant to participate in any/all of the programs sponsored by the Department of Neighborhood and Community Services (NCS). I understand that my child may be transported to other sites for additional activities during the course of their participation at the Community/Teen Center and I agree to hold harmless NCS, its employees and volunteers for injuries or damages resulting from my child’s participation in this activity. Also, I am aware that during program hours the coming and going of participants are the responsibilities of the parents or guardians of the child.

Password Settings

Password

20 Remaining Characters

Confirm Password

The password must be between 7 and 20 alphanumeric characters to include at least 1 Uppercase, 1 Lowercase, 1 Number and a special character. (Valid special characters are {}()!@#$%^&/,+_ )

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By requesting emails from Fairfax County, please know that your contact information maybe subject to the Virginia Freedom of Information Act (VFOIA).

If you do not want Fairfax County to release your address, email address and telephone number(s) to a FOIA request, please check the above. Doing so will authorize Fairfax County to protect this information. Other information you provide will be subject to VFOIA.

No, do not share my address, email, and telephone number.

When you are done entering the required information, click the Create Account button below

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