Rio Verde Foothills Alliance / Moms and Tots Membership

By my submitting my application below,
I acknowledge that I understand that:

• Participation in the Rio Verde Foothills Alliance’s Moms & Tots Network is limited to Alliance members with children.

• The following information, provided by me, shall be included in the Rio Verde Foothills Alliance’s Moms & Tots Network database.

• The information in the database shall be available only to other members of the Alliance’s Moms & Tots Network program.

• The Alliance offers this program as a courtesy for parents of young children in this rural area. The Alliance does not screen participants in this program, except by limiting participation in
the program to Alliance members. I have the responsibility to evaluate any/all participants with whom I choose to interact or allow my children to interact, prior to such interaction, as the Alliance makes no warrantees with respect to the information submitted to this Network by its members.

Parent Name
Residence Address
Phone
Child Name	M F	Age	Birth Month
Child Name	M F	Age	Birth Month
Child Name	M F	Age	Birth Month
Child Name	M F	Age	Birth Month

Please Share Names of Babysitters in Rio Verde Area
Name	M F	Age	Phone
Name	M F	Age	Phone
Do You Home School Your Children? Yes No


Rio Verde Foothills Alliance P.O. Box 27122 Scottsdale, AZ 85255