MOMS Club of Sharon, MA
MEMBERSHIP INFORMATION
AND LIABILITY RELEASE
Name: __________________________________________________________________
Address: _____________________________________________________________________________
City: ______________________________ State: ____________ ZIP: ______________
Home phone: _______________________ Cell phone: ___________________________
Email address: ___________________________________________________________
We’d like to get to know you a little bit. Please complete the following:
Your birthday: ________________
Your children: Name: _________________________ Birthday: __________________
_________________________ ____________________
_________________________ ____________________
_________________________ ____________________
Hobbies, interests: ________________________________________________________
Anything else you would like to share? ________________________________________
________________________________________________________________________
Do you have your own business? _______________
If so, what kind of business is it?_____________________________________________
How did you hear about us?
A. Internet (Google search/International MOMS Club site/Other____________________)
B. MOMS Club flyer (Where?___________________________)
C. From a member (Who?____________________________)
D. Other ___________________________________________
Have you ever been a member of another MOMS Club chapter? ___________
If so, where? ____________________________________
Would you be interested in volunteering to be an activity coordinator, staff member, or board member? __________________________________________________________
I, the undersigned, understand that my participation and the participation of any members of my family in any MOMS Club activity or program are completely voluntary, and we hereby give permission for myself and my family to join in those activities or programs. My family shall hold harmless this local MOMS Club, the MOMS Club Corporation, and any MOMS Club volunteers or representatives paid or unpaid, and/or the providers of any activity or program location and/or materials from any liability and/or responsibility for any accident, illness or injury that occurs during or as a result of any function or program. I accept that the final responsibility for my safety and that of my family rests on me.
Signed: _______________________________________ Date: ________________