To become a member of East Bay Moms for one year, please provide the following information for the Membership Roster, complete the Waiver of Liability below and attach a $90.00 check payable to East Bay Moms. Mail your completed application to East Bay Moms, 6000 Contra Costa Road, Oakland, CA 94618 or submit it to Lee Eisman at any East Bay Moms activity.

Name _________________________________________________________________

Street Address __________________________________________________________

City __________________________________________ Zip Code ________________

Home Phone _____________________ E-Mail Address __________________________

Profession ______________________________________________________________

Child(ren)'s Name(s) and Birth date(s) _________________________________________

_______________________________________________________________________

The undersigned RELEASES AND DISCHARGES East Bay Moms, Lee Eisman, and their employees, representatives and agents (collectively, the "released parties"), from any and all liabilities, claims, demands or causes of action that we may hereafter have for injuries or damages arising out of participation in any East Bay Moms activity.

This release includes, but is not limited to losses caused by the passive or active negligence of the released parties.

We understand and acknowledge that hiking, biking and other activities with children have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and WE EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN EAST BAY MOMS ACTIVITIES INCLUDING THE RISK OF PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASED PARTIES.

We understand that East Bay Moms activities require physical fitness and we believe that we are in proper physical condition to participate in the events. We will consult with our own physicians and determine our own fitness for these events. WE DO NOT RELY ON ANY REPRESENTATIONS BY THE RELEASED PARTIES REGARDING THE SEVERITY, INTENSITY OR DIFFICULTY of East Bay Moms events.