1345 Encinitas Blvd. E-125. Encinitas, CA 92024. Bus. 760-688-9819. Fax. 760-652-4807

(1) I________________________________ agree to purchase My Family Emergency Services   Emergency Membership Program. (2) I agree to give M.F.E.S permission contact the three people I have chosen to be contacted if my child to speak or unable to contact me. M.F.E.S. may give Law enforcement personnel, and rescue personnel, if my child is faced with an emergency. (3) I give M.F.E.S., and any of its associate’s permission to notify my family and friends whom I have chosen to be notified if my child is faced with an emergency. (4) I fully understand that M.F.E.S. notification hot line is not a quick respond emergency hotline, and used only to receive call from emergency personnel, and notify me and other emergency contacts within 72 hours. (5) I agree not to hold M.F.E.S. legally responsible for any false or misleading information given by me or any of my relatives joining M.F.E.S. emergency membership program. (6) I agree if I do not cancel my child’s membership at the end of my membership period, M.F.E.S. will automatically renew, and be billed each year.  I agree any cancellation must be done in writing. (7) I agree to contact M.F.E.S. within seven days of any chances to addresses, telephone numbers, and medical conditions, for any relatives I sponsor and myself on M.F.E.S. membership program. (8) I agree to provide M.F.E.S. with a recent photo of each family member on this membership program. (9) I agree and understand that I can cancel my membership at any time without cause, and there will be no refunds for this membership. (10) I understand and agree that M.F.E.S. main mission is to provide emergency ID cards, ID tags, and to notify the other two contacts listed on the notification form and myself my child is faced with an emergency. (11) I acknowledge this is a legal agreement between M.F.E.S. and me. (12) I agree that I am in my right mind, and have the capability to enter into this agreement on behalf of my child.
I am the legal parent/guardian of ____________________________________________, a minor. I agree to sign up in him/her up to MFES Emergency Membership Program as a member of My Family Emergency Services. I understand MFES notification hotline is will notify the people listed on the notification form if said minor member is unable to speak for his/her self in the invent of an emergency. I understand MFES has 48 hours to contact the people I have chosen to be contacted if my minor child is in an emergency.
Disaster Membership program
Membership Fee                      
1. Children      $37.00  
Print Name: First__________________________________________Last:_____________________________________________
Address:___________________________________________________City:_____________________St:____ Zip:_____________
Home Tel: _________________________________________________Bus:_____________________Cell:____________________
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Membership form

Parent's or Guardian's Name
Associate's Name