Membership Form

Pleasanton Mothers Club Membership Form

The Pleasanton Mother’s Club (PMC) Annual Membership Dues are $35. Our membership year runs from June 1 to May 31.

Our membership dues are prorated throughout the year, depending upon the date you join. Please refer to the membership due schedule below.

- $35 if joining between June 1 and Nov. 30
- $20 if joining between Dec. 1 and March 31
- $10 if joining between April 1 and May 31

Any non sufficient payments received via PayPal and/or checks will be subject to a $10.00 processing fee.

To send in a paper Membership Form, please return to the main Membership page.

Before filling out this form, please be sure you have read and agree to the PMC Bylaws, PMC Privacy Policy, and Playgroup Information & Guidelines (if you are planning to join a playgroup).

If you have any questions, please contact our Membership Coordinators.

*YOU MUST FILL IN FIELDS MARKED *
GENERAL INFORMATION:
*Member Name:
Spouse's Name (if applicable):
*Phone #:
*Address:
# years at present address:
*E-Mail Address:
Yahoo!ID (if any):
Mom's Birthday:
PLAYGROUP INFORMATION:
Name (first & last) Birthday Days Available for Playgroups
Child 1 M Tu W Th F
Child 2 M Tu W Th F
Child 3 M Tu W Th F
Child 4 M Tu W Th F
Child 5 M Tu W Th F
Child 6 M Tu W Th F
More Kids?
I am interested in becoming a playgroup representative.
Please check this box to indicate that you have read and agree to the Playgroup Information & Guidelines.
OTHER INFORMATION:
If pregnant, when are you due?
Which facets of PMC are most important to you?
Special Interest Groups you may be interested in joining:
Adoptive Parents
Autism Spectrum Kids
Babysitting Coop
Book Club
Bunco
Cooking Club
Gourmade Cookery
Knitting Club
Moms of Multiples 		Moms Over 40
Movie Club
Pamper Me Club
Scrapbooking
Single Moms
Tea Club
Walking/Running
Wine Club
Working Moms Group
Can you suggest some activities/outings?
How did you hear about PMC?
Special Notes:

You must agree to the following AGREEMENT
in order to maintain membership:

PLEASANTON MOTHERS CLUB WAIVER/RELEASE/INDEMNITY AGREEMENT

Definitions
"Pleasanton Mother's Club" includes but is not limited to the Pleasanton Mothers Club, its officers, Executive Board, directors, members, agents, employees, attorneys or insurers.

Intent & Purpose
The purpose of this agreement is to allow me, my family members, friends and guest to participate in the functions and activities of the Pleasanton Mothers Club (PMC).

Waiver/Release/Indemnity
I accept on behalf of myself, heirs, beneficiaries, assigns, agents, child or children, wards, next of kin, successors and conservatees, or any and all of them, any and all danger(s) and resulting personal injury (including death) and/or property damage, and I knowingly accept the following Release of Liability after having read and understood the terms thereof.

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

  • I release the PMC from any obligations or duty of care owed to me, or to any individuals for whom I am responsible;
  • I waive any and all liabilities or claims I may have or individuals for whom I am responsible may have, against the PMC for personal injuries or property damages arising out of our participation in PMC functions or activities connected to the PMC, including liability for the negligence of the PMC, its Executive Board, coordinators, sponsors, representatives, or members;
  • I agree to indemnify the PMC for 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;
  • I accept that my participation in any PMC function will be voluntary and I assume all risks related to my participation and activities connected with the PMC, and all such risks to individuals for whom I am responsible.

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

Term
I agree that this release shall be effective as long as I participate in activities connected to the Pleasanton Mothers Club, regardless of membership.

I Accept the Terms of this AGREEMENT.
By checking the above box you are officially signing the membership form and agree to all rules, regulations and policies outlined in the PMC BYLAWS and PMC Privacy Policy.
PLEASE NOTE: You must make payment via PayPal or mail in your registration fee within 10 business days or you will be removed from our membership database. Thank you!