Name*:
Baby’s Name:
Baby’s DOB (mm/dd/yyyy):
Address:
Phone (xxx-xxx-xxxx)*:
Email*:
Are you a Thoreau Club member? If so, what is your member number?
How did you hear about MOMfitters?
Are you registering for MOMfit?        Yes No	Thursdays, Sept 27th – Nov 15th (8 weeks) TC Members Free, Non Members $130/session Register by completing this online form and sending payment to Thoreau Club*
Are you registering for MOMsign?        Yes No	Mondays, Sept 24th – Nov 5th (6 weeks) TC Members Free, Non Members $130/session Register by completing this online form and sending payment to Thoreau Club*
Are you registering for MOMswim?       11:00 - 11:45 FULL       11:45 - 12:30 FULL	Wednesday, Sept 26th – Nov 14th (8 weeks) TC Members Free, Non Members $130 /session Register by completing this online form and sending payment to Thoreau Club*

*Please make checks payable to Thoreau Club and send them ATT: Meghan Brennan/MOMfitters Thoreau Club 275 Forest Ridge Road, Concord MA 01742

I, the undersigned participant in MOMfitters as a condition of my participation, hereby waive any and all claims I may have now or in the future against my instructor in connection with or arising out of my participation in this exercise class or any injury to my child or myself related thereto. I understand that any exercise program carries with it some risk. I acknowledge and accept that risk. I have consulted with my doctor and he/she agrees that this exercise program is appropriate for me given my current state of health. I hereby give permission to MOMfitters to use my photographic likeness in all forms and in all media for advertising, promotion and trade purposes and any other lawful purposes.

Type what you see here on the signature line below to agree to the above terms.

Signature*:

Date (mm/dd/yyyy)*: