St. Faustina MOMs Group
Membership Information and Liability Release
First Name *
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Last Name *
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Email Address *
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Street Address *
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City *
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State *
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Zip Code *
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Subdivision/ General Area
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Cell Phone
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Home Phone
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Registered Parish
Husband's Name
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In what activities are you most interested? *
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Required
Child's Information
Name, DOB, and Gender
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Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
Child's Information
Name, DOB and Gender
Your answer
I, the undersigned, understand that my participation and the participation of my child(ren) in any MOMS Club activity is completely voluntary on my part, and I thereby give permission for myself and my child(ren) to join in these activities. I shall hold harmless St. Faustina's MOMS, its volunteers, employees both paid and unpaid representatives, and/or the provider of the meeting/activity location from any liability or responsibility for any accident, illness or injury that occurs during or as a result of those activities. I accept that the final responsibility for my safety and that of my child(ren) rests with me.
Electronic Signature and Date
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