Waiver and Release Form

Please print this page and submit it along with your payment.


I, the undersigned, understand that my participation and the participation of my child/children in any Eastside Mothers 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 Eastside Mothers Club, its volunteers, caregivers and representatives, and/or providers of the meeting/activity locations, 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.

I understand that photos of myself or my child(ren) may be used on the EMC members-only website. This website is password-protected. (NOTE: If you do not wish photos of yourself or your children to be displayed, please email our webmaster at webmaster@eastsidemothersclub.com to let her know, and also send her a photo so she can try to watch out for you in photos.)
AGREE / DISAGREE

I understand that photos of myself or my child(ren) may be used for promotional purposes.
AGREE / DISAGREE
 

____________________________________ Date: __________________
Parent’s Signature
 
____________________________________
Parent’s Printed Name

Our membership fee is $35.

To join EMC, please print this page and mail it, along with your check (made out to EMC) to:

Eastside Mothers Club
P.O. Box 2611
Kirkland WA  98083-2611

or bring this page and your check with you to your next EMC event. You may also send payment through Paypal to payments@eastsidemothersclub.com (please note that we cannot accept credit card or debit card payments on Paypal – funded transfers only). Please include your name in the Note field on Paypal, and please bring a signed copy of this page with you to your next EMC event.

Questions? Send email to membership@eastsidemothersclub.com.