WCCA Sign-Up Form

Thank you for joining the WCCA. Kindly fill out the information below and check all appropriate boxes. You have two payment options -- online payment through Paypal or check to be mailed in with the printer-friendly form that is generated at the end of the online registration process.

Contact Membership Chair Cat Niemann, (781) 894-3031, niemanns@comcast.net with any questions.

Member Information

Please enter information as you would like it to appear in the Membership Directory. Renewing members should use the same last name as in prior years to prevent duplicate records. If your last name has changed, please contact the Membership Chair.

New Member

Renewing Member

Email address:

Confirm email:

MOTHER:

First: Last:

FATHER:

First: Last: (if different)

Street Address:

Town

Zip Code:

Home phone #:

format: (781) 899-1234

Only include your child's last name if different from mother's last name above.

Children	Birth Date (mm/dd/yy, example: 01/31/07)
1.	/ /
2.	/ /
3.	/ /
4.	/ /
5.	/ /
6.	/ /

Please check here if you would like to receive all WCCA correspondence, except the newsletter, via email instead of posted mail.

Your interests

You will be automatically signed up for age groups based on your child/children's birth date.

Age Group		Birth Dates
Blue Whales		9/1/2007-8/31/2008
Rhinos		9/1/2006-8/31/2007
Bengal Tigers		9/1/2005-8/31/2006
Bald Eagles		9/1/2004-8/31/2005
Koalas		9/1/2003-8/31/2004
Sea Turtles		9/1/2002-8/31/2003
School Age		before 9/1/2002

Check below to indicate which other activity groups are of interest to you:

Dad's Group Dual Career

If Dad's group has been selected:
preferred email address to reach Dad:

Check below to indicate your willingness to help in any of the following areas:

Assisting with Children's Events	Participating in Outreach Programs
Assisting with Family Events	Participating in Parent Discussion Groups
Assisting with Library Events	Volunteering your home for an Adult Event
General Interest	Welcoming New Members

Liability Waiver

My family and I, including my child/children, may participate in programs and activities sponsored by the Weston Community Children’s Association (“WCCA”). I agree to waive, on behalf of myself and my family, any claims which any of us may have against the WCCA and/or its organizers, directors, members, sponsors or hosts for WCCA programs or activities including without limitation in connection with any accidents, physical injuries, emotional distress or property damage arising out of a WCCA program or activity. We waive such claims in recognition that the WCCA is a volunteer, not-for-profit organization and that the absence of such waivers on the part of participants would be a deterrent to WCCA programs and activities.

Yes, I accept the liability waiver.

Calculate your total payment

Dues cover the period May 31, 2007 - June 1, 2008. Dues may be waived under special circumstances. Please contact Diane Douglas, the current WCCA President, at 781-790-1023 to discuss the matter confidentially. Note that membership dues do not cover our annual operating expenses. Please consider an additional donation.

Dues:	$55
Donations:	$

Submit Form