MOPS & Childcare Registration 2022/2023

Moms who are registering in MOPS or MOMSNEXT (and, not in MOPS previously) for the first time will receive discounted registration cost! (Select "First Time Member" in the payment section.)

We will offer ONSITE only.

Registrant's information:

Name

This address will receive a confirmation email

Phone

Address

Birthdate - dd/mm/yyyy

Emergency Contact: (please list full name and phone number)

Do you have a home church? (If so, please list the name of the church and the city and state where it is located. If not, please type "No".)

Which group are you joining?

MOPS (Mothers of Preschoolers) MOMSnext (Mothers of school-age kids)

May we publish your contact information in our local MOPS/MOMSnext directory?

Yes No Not sure, I would like more information

Are you a Mentor Mom?

Yes No

How did you hear about MOPS/MOMSnext?

Family's Information:

Do you need childcare for a 1-year old to 5th grade age child during MOPS/MOMSnext? If yes, please fill out information for each child that will need childcare. If no, please skip to payment section.

Please fill out the following information for each child in need of childcare during MOPS/MOMSnext. If you are registering more than 3 children, email the additional children's information to mops@firstfree.org and copy Pastor Robyn at robynfoye@firstfree.org.

Child #1 Full Name:

Gender: Male Female

Birthdate: (dd/mm/yyy)

Allergies and treatment:

Child #2 Full Name:

Gender: Male Female

Birthdate: (dd/mm/yyy)

Allergies and treatment:

Child #3 Full Name:

Gender: Male Female

Birthdate: (dd/mm/yyyy)

Allergies and treatment:

We have limited scholarships available to those in need. If you would like to request a scholarship, please check the option below and the "Scholarship Request - Pay Later" option in the payment section.

Scholarship options: Full Scholarship needed Partial Scholarship needed

Payment (debit or credit card only):

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

MOPS & Childcare Registration 2022/2023

Description

Please Fix the Following