MOPS Registration 2017-2018
 
MOPS Registration 2017-2018
Your Info
Last Name  * 
First Name  * 
Cell Phone  * 
Text okay?  * 
Address  * 
City  * 
State  * 
Zip  * 
Birthday
Have you attended a MOPS group before?  * 
If yes, where?
Are you already registered for the MOPS International Membership?  * 
Home church (if applicable)
How did you hear about this MOPS group?
Does WBCC/MOPS have permission to photograph/video the listed mom to be in church/MOPS publications, social media, and displays? No names/info will be disclosed.  * 
Emergency Contact  * 
Phone  * 
Address
MOPS Kids Registration Info
Child's Full Name  * 
Child's Birthdate  * 
#2 Child's Full Name
#2 Child's Birthdate
#3 Child's Full Name
#3 Child's Birthdate
#4 Child's Full Name
#4 Child's Birthdate
Does WBCC/MOPS have permission to photograph/video the listed minor(s) to be in church/MOPS publications, social media, and displays? No names/info will be disclosed.  * 
Special needs, instructions or allergies (please specify child(ren) this applies to)
Father's Full Name
Home Phone
Alternate Phone
Who has permission to pick up your child(ren) in case of emergency? Please list Father (name & phone), Relative (name & phone) and Other (name & phone) as applicable. * 
Family Doctor Name  * 
Phone
Address
Registration is $75. A minimum payment of $30 is required to reserve your spot.
Payment amount today $ 
I would like to be emailed regarding scholarships or payment plans.
I would like additional information regarding...
Your Email Address  * 
Total $
 
 
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