MOMS Club® of Madison County, MS - Membership Form & Liability Waiver
Our bylaws require that all members have a current liability form on file with the club. If you prefer to submit a paper form, contact us at momsclubmadisonms@gmail.com.
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About You
This information may be included in our group roster which is shared only with other members in good standing.
Your MOMS Club History *
Required
First Name *
Last Name *
Address *
City *
State *
ZIP Code *
Phone Number *
Email Address *
Mom's Birthday *
MM
/
DD
About Your Family
Spouse's Name *
If you don't have a "significant other," just enter N/A here
Children *
List name and birth month/year, for example: Adam (Jan 2011), Beatrice (Feb 2013), Charlie (Mar 2015)
Special Circumstances
If you or any of your children have special concerns that you'd like the group to know about (food allergies, medical conditions, etc.) please explain.
Liability Waiver
I understand that my participation and the participation of my child/children in any MOMS Club® activity is completely voluntary on my part, and I hereby give my permission for myself and my child/children to join in those activities. I shall hold harmless the MOMS Club (local, regional, national, international, and corporation), its volunteers, employees, paid or unpaid representatives, and/or the providers 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/children rests with me. *
Required
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