MOMS Club NELA Membership Information and Liability Release Form
All members must have a sign Membership Information and Liability Release on file with the local MOMS Club before attending any activities or programs.
First and Last Name: *
Address: *
Zip Code: *
Telephone: *
Email: *
Your Birthday: *
Month and Day
Spouse's Name: *
1) Child's Name: *
1) Child's Birthday: *
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2) Child's Name:
2) Child's Birthday:
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3) Child's Name:
3) Child's Birthday:
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4) Child's Name:
4) Child's Birthday:
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Have you ever been a member of this or any other local MOMS Club? If so, which chapter and when? *
Do you work for pay or do volunteer work? If so, what do you do?
This information may be included in the group roster or newsletter. It will also help us plan future activities. If you have an idea for the group, please discuss it with a member of the Executive Board!
What are your hobbies or special interests?
This information may be included in the group roster or newsletter. It will also help us plan future activities. If you have an idea for the group, please discuss it with a member of the Executive Board!
How did you hear about us? *
I, the undersigned, understand that my participation and the participation of any members of my family in any MOMS Club activity or program is 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 MOM Club volunteers or representatives, paid or unpaid, and/ or the providers or 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 functions or program. I accept that final responsibility for my safety and that of my family rests with me. *
Required
Signature: *
Please type your email address to serve as your signature agreeing to the terms above.
Today's Date: *
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Code of Conduct *
To ensure the comfort of moms from all economic and cultural backgrounds, we ask the all members follow the following guidelines.
Required
Sick Child Policy *
Members shall not bring a child to ANY activity that has been ill or have had symptoms (such as vomiting or diarrhea, extreme lethargy, oral temperature of 100+ degrees, severe cough or pain, discharge from the eyes, green mucus, or any other communicable disease, such as chicken pox, etc)
Required
Children's Behavior Guidelines *
MOMS Club activities are meant to be enjoyable and safe events for both parents and children. MOMS Club respects parenting differences but expects that all children behave appropriately at MOMS Club activities. Unacceptable behavior include but are not limited to: Hitting, Pushing, Scratching, Kicking, Biting, Spitting, Slapping, Hitting with Objects, Hair Pulling, Destroying Property, Inappropriate touch, Overly-aggressive behavior. In the unfortunate event that these behaviors occur during MOMS Club activities, then the child’s mother should remove her child from the area. When disciplining, please remove the child from the immediate area and do so in a reasonable tone of voice so as not to further disrupt or alarm others in the group. In situations that involve unacceptable behaviors, if the behavior is attempted, his/her mother should remove the child from the area for an appropriate period of time out. The child’s mother will be expected to keep an especially diligent watch over the child if attempt to inflict harm on another child is made. If the child attempts the behavior a second time at the same activity, the mother must remove the child from the MOMS Club activity for the day. If any of these behaviors occur, the mother and child shall leave for the day. If the child returns to another MOMS Club function and demonstrates the same negative behavior, then the mother must immediately remove the child and cannot return to a MOMS Club activity until the child stops the negative behavior altogether.
Required
Moms Behavior Policy *
MOMS Club is here to support mothers who choose to stay at home with their children. We support all mothers and recognize that there are many different parenting styles and personalities in our club. To ensure a safe, supportive atmosphere, we ask the following of all members (Please check each box):
Required
In the unfortunate event that these guidelines are not followed the witnessing party shall contact the Executive Board, which will discuss the issue with the member(s) involved and as the authority to impose penalties as follows: *
First Offense: Verbal Warning Second Offence: Written Warning Third Offence within one calendar year: The member will be allowed the opportunity to state her case before the board and/or membership before the board is allowed to revoke membership. This may result in the member losing her membership and forfeiting her dues.
Required
Code of Conduct Signature: *
Please type your email address to serve as your signature agreeing to the terms above.
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