BEACH CITIES PARENTS OF MULTIPLES ASSOCIATION (BCPMA)
ENROLLMENT FORM

This form is for new members only. If you would like to renew your membership please fill out the form here. This form is also only for new members who would like to pay their dues via Paypal (We charge a $1.50 convenience fee for the use of Paypal.) If you would like to pay by check, please print out the form here, fill it out, and send it along with a check to BCPMA Membership, Lorrie Joyce, 2611 Graham Ave, Redondo Beach 90278.

Instructions

1. Please fill out your contact and multiples information below.

2. Date and initial after reading the RELEASE, WAIVER, AND INDEMNITY AGREEMENT below.

3. Choose a membership option.

4. Press submit and your application will be emailed to Lorrie Joyce. Please pay your dues via Paypal after you submit your application. Please contact Lorrie Joyce if you have any questions.

Family Name:

Home Phone: (required)

Mother's Name:

Work Phone:

Mother's Maiden Name:

Father's Name:

Work Phone:

Home Address:

City:

Zip: (required)   

Email Address: (required)

(Your e-mail address will appear on the club roster and will be used to send your newsletter and notices of upcoming events)

Please read the following carefully before signing this application.

RELEASE, WAIVER, AND INDEMNITY AGREEMENT

In consideration for my acceptance and my family’s acceptance as members of the Beach Cities Parents of Multiples Association, Inc. (the “BCPMA”), and the services and amenities to be provided by BCPMA and its officers, directors, representatives, volunteers, and successors (the “Releasees”) in connection with BCPMA activities and functions, I agree as follows on behalf of myself and all members of my family, including minor children:

• To the fullest extent allowed by law, I hereby release, waive, discharge, and covenant not to sue the Releasees from any and all liability to me on account of, or in any way resulting from, any loss or damage, and any claim or demands for loss or damage, on account of injury to the person or property, whether caused by the active or passive negligence of the Releasees or otherwise, in any way connected with any functions or activities of the BCPMA.
• To the fullest extent allowed by law, I further agree to indemnify and hold harmless the Releasees and each of them from any liability, claims, damages, injuries, costs, or losses caused by my own negligence or the negligence of any of my family members, including minor children, while a participant in or observer of any BCPMA functions or activities.
• I understand and intend that this Release, Waiver, and Indemnity Agreement is effective and binding upon myself and my heirs, assigns, personal representative, and estate, and for all members of my family, including minor children.

Submission of this application constitutes agreement to abide by BCPMA’s Constitution and Bylaws.

Date:     Initials: 

If you will be accompanied by a minor to any BCPMA activities or functions, the minor’s parent or legal guardian must sign this Release, Waiver, and Indemnity Agreement on behalf of the minor.

I hereby agree and consent to the foregoing Release, Waiver, and Indemnity Agreement on behalf of each minors listed below:

MULTIPLES INFORMATION (please fill out for each child)

Number: Twins  Triplets  Quads  Other

OTHER CHILDREN

DUES
Dues for one year are $31.50. (We charge a $1.50 convenience fee for the use of Paypal.)

MEMBERSHIP OPTIONS (you will be taken to our Paypal payment page as soon as the form is submitted.)

Other Comments: