Please indicate
Member
First Name*
Last Name*
Nickname/Name for Club Badge
Address*
City*
State*
Zip*
Telephone*
Cell Phone
Email Address*
Birthday (birth year optional)
Partner
Partner's First Name
Partner's Last Name
Children
Children's Names (if pregnant, write "Expecting") Gender Dates
of Birth (or Due Date)
Other
Occupational situation
Would you or your partner be interested in joining the following email lists?
E- News Announcements - Self:
To meet more families that share your interests, would you or your partner
be interested in participating in the following subclubs? (Check all that apply.)
Are you interested in organizing a subclub? About what?
The Mothers' Club is run completely by volunteers. All members are required
to volunteer 4 hours of service to the club during the year. In which activities
would you like to participate to fulfill your requirement? (Check all that apply;
you must check at least one.)
Do you have any special skills or resources that you would like to contribute
to or share with the club? Please list them.
How did you find out about the club?
What do you hope to get out of the club by joining? (i.e. joining a playgroup,
receiving the newsletter, meeting other moms) How can we help you realize these
goals?
Privacy Notice
Some of this information will be made available to other members in our Club
roster in print form and online. We will be offering a membership directory online
in a password protected members only area of our website. If you have any information
which you would not like shared, please let us know here.
Acknowledgement and Liability Waiver
We have been advised, for the protection of all club members, that parents
must be responsible for the safety and behavior of their own children and themselves,
and that all members should sign an acknowledgement of their responsibility.
In order to participate in the club, and to protect yourself and your friends
and family, you must sign and return this "Acknowledgement and Liability
Waiver" with your membership dues. I hereby acknowledge and understand that
I am responsible for the safety and behavior of my family and my guests at all
club functions. By submitting this application on-line you agree to this
waiver.