Welcoming all mothers to join in on this journey of motherhood and sisterhood in our small community

Please check one

Full Name

First NameLast Name

Alternate Name Used in Facebook

Home Phone #

Area CodePhone Number

Mailing Address (if different than above)

Mailing Address

Mailing Address Line 2

City

Postal / Zip CodeCountry

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail Address

Your Birthday

Month

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Date

First name

First nameBirthday

First name

First nameBirthday

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Additional children:

How did you hear about the Mothers' Club of Amador County?

If you are pregnant, when are you due?

Meals are provided by our awesome volunteering mommas for mommies with new babies. If you are pregnant now and are interested in recieving meals, you will be contacted by our meals coordinator- mothersclubofamadorcounty@gmail.com

***New-Member Contribution Form****
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The Mothers' Club of Amador County continues to provide ongoing events and support for a nonimal annual contribuiton of $20 or 2 hours of volunteering!

Please Note: The Mothers’ Club of Amador County cannot guarantee that it can meet all the special needs you have listed; however, the Club will try to accommodate your needs wherever possible. Member often post locations and times for our playgroups on our private Facebook page. Please be on the lookout after your application has been recieved.

Intent and Purpose

The purpose of this agreement is to allow me to participate in the functions of the Mothers’ Club of Amador County.

Waiver/Release/Indemnity

I understand that the Club requires me to be responsible for the safety and conduct of myself, my family members and my guests while participating in all Club activities. I also understand that the Club requires all other family members to be similarly responsible for themselves, their families and their guests. I therefore make the following agreement:

1. I release the Club from any obligations or duty owed to me, or to any individuals for whom I am responsible.

2. I waive any and all liabilities or claims I may have, or those that individuals for whom I am responsible may have, against the Club for personal injuries or property damages arising out of our participation in the Club functions or activities connected to the Club, including liability for the negligence of the Club, its Steering Committee, Coordinators, sponsors, representatives or its members.

3. I agree to indemnify the Club of any and all liabilities and claims arising from my own conduct or negligence, or the conduct and negligence of individuals for whom I am responsible.

4. I accept that my participation in any Club function will be voluntary and I assume all risks related to my participation and activities connected with the Club, and all such risks to individuals for whom I am responsible.

No Warranties

I acknowledge that the Club makes no warranties regarding insurance coverage for any member, participant, host, sponsor, or facilities connected with the Club activities and functions.

Please contact Our mothers club-

Mothersclubofamadorcounty@gmail.com

By typing my name I declare the information above is accurate and complete. By typing my name I also agree to comply with the information stated above in the waiver/release/indemnity agreement.

First NameDate

By checking this box I declare I have read and agree to the waiver/release/indemnity agreement stated above. Furthermore I agree that this release shall be effective as long as I participate in activities connected to the Club, regardless of membership.

Mothers’ Club of Amador County

Children:

Meals for Moms

Volunteering

Mothers Club of Amador County Waiver/Release/Indemnity Agreement

Intent and Purpose

Waiver/Release/Indemnity

No Warranties

Questions: