HIWS Junior Board Application

Hinsdale Infant Welfare Society Junior Board

NAME

SIGNATURE

SCHOOLGRADE

ADDRESS

CITY

ZIP CODE

CELL PHONE

Format: (000) 000-0000.

EMAIL

example@example.com

MEMBER SINCE

OR NEW MEMBER

TSHIRT SIZE

PARENT NAME

PARENT EMAIL

example@example.com

EMERGENCY CONTACT INFO

PARENT AGREEMENT: I hereby grant permission for photographs of my child to be used to promote the Infant Welfare Society Hinsdale Chapter Jr. Board activities. I hereby release the Infant Welfare Society of Chicago Hinsdale Chapter, its members, and chaperones from any claims or liability relating to or arising from my child's participation at meetings and events.

Parent Signature

JUNIOR BOARD CHAIRS: GINGER KROLL (GINGERKROLL@ME.COM)/MEGAN MADURI (MEGANMADURI@GMAIL.COM)

INFANT WELFARE SOCIETY) OR ZELLE AT hinsdaleiwsjuniorboard@gmail.com. FORMS CAN BE EMAILED OR MAILED TO

DUES: $50 PLEASE SUBMIT THIS FORM ALONG WITH PAYMENT FOR YOUR DUES VIA CHECK MADE PAYABLE TO HIWS (HINSDALE GINGER KROLLAT: 5751 S. THURLOW STREET, HINSDALE, IL 60521