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Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
Information for: Username : Please enter a valid username. No spaces, at least 3 characters and contain 0-9,a-z,A-Z
Information for: Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
Information for: Verify Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
Information for: Do you wish to join the MHMC Babysitting Cooop? : If you wish to join the Babysitting Coop, all fields must be completed for each member of your family as well as the additional information requested in the Babysitting Coop section of this form.
Information for: Do you wish to participate in the Helping Hands Program? : The Helping Hands Program provides meals to MHMC Members that have recently added a new child to their family.  Meals are made by participating Members.
Please tell us a little about your family.  If you are interested in becoming a member of the Babysitting Coop, please complete all fields associated with each member of your family.
Information for: Partner's Email : <p>The Partners of our Members are able to recieve newsletters and participate in many of our activities, as well as Dad's Night Out.  Please provide an email address for your partner if they wish to be included.</p> <p> </p> <p>If you are registering for the Babysitting Coop, this is required.</p>
Information for: Partner's Cell Phone : This is required for Babysitting Coop registration.
Information for: Is this child potty trained? : This information is required for Babysitting Coop membership.
Information for: Is this child potty trained? : This informaiton is required for Babysitting Coop membership.
Information for: Is this child potty trained? : This information is required for Babysitting Coop membership.
Information for: Is this child potty trained? : This information is required for Babysitting Coop membership.
Information for: Is this child potty trained? : This information is required for Babysitting Coop membership.
Information for: Is this child potty trained? : This information is required for Babysitting Coop membership.
If you are interested in becoming a member of the MHMC Babysitting Coop, please complete each of the following fields.
Information for: Please share any information regarding your child(ren) that a sitter would need to know. Consider all health, developmental, and behavioral issues. : This information would include things like allergies, special diets, fears, developmental delays, etc.  If your child has an issue that you don't care to have listed in your profile, you do not need to provide that information here.  However, you will need to disclose that information to other Babysitting Coop Members whose child(ren) will interact with yours becuase of childcare needs or who will be caring for your child(ren).<br />
Information for: Please list the names of anyone living in your home over the age of 18. : This includes older children, grandparents, extended family, and any visitors staying with you for more than three months.
Information for: Emergency Contact Name : Please provide the name of someone besides yourself and your partner that can care for your child in an emergency.
Information for: Emergency Contact Phone : Please provide a phone number for your Emergency Contact.
Information for: Pediatrician's Name : Please provide the name of your child's pediatrician.
Information for: Pediatrician's Phone Number : Please provide a phone number for your pediatrician.
Information for: I agree to complete a Medical Consent Form for my child(ren). : This form will be reviewed with you during your Safety Visit.  A current form must be kept on file with the Babysitting Coop Chair in order for you to participate in the Babysitting Coop.  The form provides consent for a sitter withing the Program to take your child to the nearest emergency center or call 911 in the event that the child becomes seriously ill or injured.
Information for: CPR Certification : Please select all that apply.
Information for: Please tell us about each of your pets. : Please include information about breed, size and demeanor toward children.
 
Thank you for joining the Mountain House Mothers Club. By accepting the above Terms & Conditions, you are agreeing to the MHMC Bylaws. Your registration requires approval. Please follow the instructions contained in the "Your MHMC Registration is Pending Approval" email that was sent to the email address you provided. Please contact either the Membership Chair at mhmcmembership@gmail.com or the President at mhmcpresident@gmail.com with any questions you might have.
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