CMC Membership Form 2018-2019
To join: Please complete the following form and hit submit at the very bottom of the form. A copy of your responses will be emailed to the address you provided. Then click on our Paypal payment button (if you do not have a Paypal account, you can use a credit card via the Paypal payment site). Once we have received both your payment and completed form your information will be processed and you will receive a welcome email from the club, a calendar of events and the most recent newsletter. Thank you for joining Chico Mothers Club! ***NOTE: we have found that it works best to fill out the form via computer vs. phone. We have had some issues with the form not going through from the phone. ***
Email address *
General Membership Information
Your Name (First & Last) *
Your answer
Email Address *
Your answer
Are you a new or renewing member *
Facebook Name *
We require a FB account for membership. *About 95% of our communication is done via our closed FB pages. In order to get the most out of the club we require having a FB account. We have past and current members that have created accounts, with minimal information to maintain privacy, just to gain access to CMC information.
Your answer
What is the best way to contact you? *
Street Address *
Please include your complete home address including any apartment or suite numbers.
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Your birthdate *
MM
/
DD
/
YYYY
Your partner's name
Your answer
Child #1's Name *
Your answer
Child #1's Birthdate *
MM
/
DD
/
YYYY
Child #2's Name
Your answer
Child #2's Birthdate
MM
/
DD
/
YYYY
Child #3's Name
Your answer
Child #3's Birthdate
MM
/
DD
/
YYYY
Child #4's Name
Your answer
Child #4's Birthdate
MM
/
DD
/
YYYY
If pregnant, when are you due?
MM
/
DD
/
YYYY
What can we do for you?
How did you learn of Chico Mothers Club? *
Please be specific- Friend (if they are a member, please list their name), Facebook, Sweet Repeats, Children's Faire, Google Search, Growing Up Chico, etc. Thank you!
Your answer
Which facets of Chico Mothers Club most interest you? (Mark as many as apply) *
Required
NEW MEMBERS: Are you interested in being set up in a playgroup? *
Playgroups foster friendships, support, and socialization. Not only are they great for Moms but, they help our kids learn how to play with others, build friendships, and share. Playgroups are one of the BEST reasons to be apart of the Chico Mother's Club! Our playgroups meet weekly, same time, same day. They are age based with siblings welcome. Members take turns with hosting duties which typically means choosing the location where the group will meet, your home, park, library, etc.. basically any kid friendly place. Each of our playgroups has closed Facebook pages that they communicate on. Playgroup members also take turns serving as the playgroup leader. Because we are a co-op run club our playgroups take turns planning the monthly calendar of all club wide events, delivering magazines,planning parties or working on a community outreach project. In order to build a strong, successful playgroup we do ask that playgroup members commit to the playgroup and be an active and communicative participant.
CURRENT MEMBERS: Are you currently in a playgroup? *
CURRENT MEMBERS: What is the name(s) of your current playgroup(s)? *
If you are a new member or a renewing member that does not have a playgroup put N/A
Your answer
Is there anything in particular you are looking for in the Chico Mothers Club?
Your answer
Are there any hobbies, talents, or skills that you would be willing to share with the club?
Your answer
Do you have any ideas/requests for speakers or presentations for membership?
Your answer
Do you have any ideas/requests for field trips?
Your answer
Would you be interested in volunteering in a position on our Steering Committee (our clubs governing board). Joining the Steering Committee is a great way to get more involved in the club, the community and to give back to the club. We are 100% volunteer run. *
Payment and Legal Stuff
Our fiscal calendar begins in June, and annual dues are $36.00. If you join in a quarter other than June, dues are prorated as follows:

May - November = $36
December - April = $18.00
** If you join in May, you pay $36 for membership for the next fiscal year, and you get May for FREE, like a buy 13 months for the price of 12 months!

Below is our Liability Waiver and News, Video and Photography Release Form. Please read both and place your name in the space provided. This will serve as an "electronic signature" recognizing that you have read and understand both documents. These will be submitted to our membership coordinator with your payment.


Please read and type your FULL name (first and last) in the space provided as recognition that you have read and understand the waiver. *
CHICO MOTHERS’ CLUB LIABILITY WAIVER I understand that participation in activities with the Chico Mothers' Club is voluntary and that I am responsible for my child (children) and myself/spouse/or guests at all times during activities through the Chico Mothers' Club. I hereby waive, release and discharge any and all claims for damages for personal injury, death or property damage which I may have, or which may hereafter accrue to me, as a result of participation in Chico Mothers' Club activities. This release is intended to discharge in advance all members of the Chico Mothers' Club (its Steering Committee members, and all those who may volunteer their homes or services) from any and all liability arising out of or connected in any way with my participation in Chico Mothers' Club sponsored activities, even though that liability may arise out of negligence or carelessness on the part of the person or entities mentioned above. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns I agree to indemnify and do hold the above persons or entities free and harmless from any loss, liability damage, cost or expense which they may incur as the result of my death or injury or property damage that I may sustain while participating in said activity. I have carefully read this agreement, waiver and release and fully understand its contents. I am aware that this is a release of liability and contract between myself and the Chico Mothers' Club and I sign it of my own free will.
Your answer
News, Photo and Video Release Information
Chico Mothers’ Club is occasionally asked for information about our program. We would like to present general information to other agencies or the public in order for them to understand our program and this often times includes photos. Photos are sometimes posted on our closed Facebook page, public Facebook page, and member newsletter. Photos may also appear on websites/Facebook pages of places we visit/tour as a club, print publications, online publications, presentations, websites, printed materials used to promote CMC and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
I have read and understand the photo release regarding use of photos and/or videos for the Chico Mothers Club. Please type your FULL name (first and last) below to indicate you have read and understand the photo release. *
Your answer
I am paying for my membership via: *
Required
If the name on your PayPal account, is different than the name on your membership form, please list it below. (i.e. PayPal is in your maiden name or you are using your husbands or parents PayPal)
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.