Membership Form

Mansfield Mothers' Club

The Mansfield Mothers’ Club, in Mansfield, MA, aims to provide support for local parents. Our organization has more than 150 members. Our goals include providing a forum for relevant topics to parents, engaging in activities that enrich the lives of our children, as well as performing service projects that benefit families and children. Please fill out this form, click the Liability Release, and make payment through PayPal to join the club. Thanks!

1. Parent/Guardian One

Name *

Parent/Guardian Two (If applicable) Name

Street Address *

City

ZIP / Postal code

Country

Email Address *

Phone *

Email *

Confirm Email Address *

2. Children in Your Household

Please include your children's names and birthdates to help us set up playdates and plan age-appropriate activities for the club.
(To add more children, please click the + sign next to the "Birth Date" text field.)

Child 1 First Name *

Child 1 Last Name *

Child 1 Birth Date

Child 2 First Name *

Child 2 Last Name *

Child 2 Birth Date

Child 3 First Name

Child 3 Last Name

Child 3 Birth Date

3. Would you like to join an age-appropriate playgroup?

If yes, which days/times work best for you and what ages are you most interested in? Would you be open to hosting your playgroup in your home/yard?

4. More About You

Please tell us about your family. For example, What do you (or did you) do for work? Where did you grow up? What are your hobbies/interests? Your family's favorite activities? Etc. This will be posted in our newsletter as a way to introduce you to members! *

Family PhotoOptionally, provide a family photo. By uploading a photo here, you consent to Mansfield Mother's Club including this image in social content, such as the monthly newsletter.

No file chosen

May we announce your child(ren)'s birthdates in our monthly newsletter? *YesNo

5. Liability Release

By clicking below I, the undersigned, understand that my participation and the participation of any members of my family in any Mansfield Mothers’ Club activity or program is completely voluntary, and hereby give permission for me and my family to join in those activities or programs. My family shall hold harmless this local Mansfield Mothers’ Club, the Mansfield Mothers’ Club Corporation, any Mansfield Mothers’ Club volunteers or representatives, paid or unpaid, and/or the providers of any activity or program location and/or materials from any liability and/or responsibility for any accident, illness, or injury that occurs during or as a result of any function or program. I accept the final responsibility for my safety and the safety of my family rests with me.

Do you accept the conditions in the Liability Release? *Yes

6. Purchase Your Household Membership

1-YEAR HOUSEHOLD MEMBERSHIP
Price: $25.00
Processing Fee
$2.00
Total
$27.00