2018-2019 MOMS Club of Norwell Membership Information & Liability Release
Please fill out the form with your contact information, hobbies/interests, etc. This information will help us plan activities that are of interest to our members. We need you to fill out a new form each year and don't forget to pay your dues after submitting the form. We hope to see you at a MOMS Club event soon!
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone *
E-Mail *
Your Birthday
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Current/Former Profession/Employer
Partner's Name
Child #1 Name
Child #1 Birthday
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YYYY
Child #2 Name
Child #2 Birthday
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DD
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YYYY
Child #3 Name
Child #3 Birthday
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Child #4 Name
Child #4 Birthday
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Child #5 Name
Child #5 Birthday
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Allergies for any family member:
Emergency Contact Name *
Emergency Contact Number *
Are you a New or Renewing Member?
New Members - How did you hear about us?
Prior Member in another chapter?
Clear selection
Hobbies/Interests
Please list a few of your hobbies and interests so that we can plan our Mom's Night Out and other events.
Best days for you + your child(ren) to join us for an activity? (Check all that apply)
Best time of day for you and your child(ren) to attend activities:
Interested in participating in any of the following: (Check all that apply)
Ideas/suggestions to improve or make the club better?
If you would like to be added to the MOMS Club of Norwell's private Facebook page (visible to members only) please type your alias below:
We respect your privacy. At times we take pictures at our events and may post them in our newsletter, in the Mariner, on our private Facebook page, or at our Open House, etc. Please check the appropriate box below: *
Required
We may circulate a member list only among MOMS Club of Norwell members which would include names, addresses, phone numbers, and e-mail addresses. Please check the appropriate box below: *
Required
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.
Full Name *
Date *
Please click the PayPal Link https://www.paypal.me/MOMSClubofNorwell/20 to submit your Annual Dues of $20, and then return here to click "Submit" below. If you do not have a PayPal account, you can still click the link to process payment with your credit/debit card. If you prefer to send a check, please make it out to MOMS Club of Norwell, and send it to Christine Johnson, 89 High Street, Norwell, MA 02061. Thank you.
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