EmailMeForm
Friday Day MOPS 2018-19
Welcome to MOPS! Please complete this form so that we can learn some basic information about you. Please note: your MOPS International fee/initial deposit holds your spot in MOPS and your children's places in MOPS Kids.
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
###
-
###
-
####
Email
*
Confirm
TELL US ABOUT YOUR FAMILY & CHURCH
Married?
*
Yes
No
Husband's name
First
Last
Your birthday
MM
/
DD
/
YYYY
Your anniversary date
MM
/
DD
/
YYYY
Are you or your husband in the military?
Yes, my husband is in the military.
No
Yes, I am in the military (fill in branch below).
What branch of the military is your husband in?
Your home church:
*
If you don't have a church that you regularly attend, please put in N/A.
TELL US ABOUT YOUR EXPERIENCE WITH MOPS
How many years have you participated in Lighthouse MOPS?
If you were at MOPS last year, which table did you sit at?
Would you like to receive emails from MOPS International?
Yes
No
ALL CHILDREN 0-5 YEARS MUST REGISTER!!
Please register your nursery/infant children as well as your older preschoolers!
TELL US ABOUT YOUR CHILDREN
CHILD 1
Child 1's name
*
First
Last
Child 1's gender
*
Female
Male
Child 1's date of birth
*
MM
/
DD
/
YYYY
List allergies/special needs for Child 1:
Will child 1 attend MOPS Kids (preschoolers only)?
*
Yes
No
Child 1's number of months old as of September 2018.
*
This info will be used for placing children into the correct MOPS Kids group.
Do you have a second child?
*
Yes
No
CHILD 2
Child 2's name
*
First
Last
Child 2's gender
*
Female
Male
Child 2's date of birth
*
MM
/
DD
/
YYYY
List allergies/special needs for Child 2:
Will child 2 attend MOPS Kids (preschoolers only)?
*
Yes
No
Child 2's number of months old as of September 2018.
*
This info will be used for placing children into the correct MOPS Kids group.
Do you have a third child?
*
Yes
No
CHILD 3
Child 3's name
*
First
Last
Child 3's gender
*
Female
Male
Child 3's date of birth
*
MM
/
DD
/
YYYY
List allergies/special needs for Child 3:
Will child 3 attend MOPS Kids (preschoolers only)?
*
Yes
No
Child 3's number of months old as of September 2018.
*
This info will be used for placing children into the correct MOPS Kids group.
You will now have the opportunity to pay online either
1) a $31.95 deposit (reserves your spot in Friday MOPS and your children's places in MOPS Kids) and pay the balance later
or
2) the full $98 registration fee today.
To pay by check or cash, bring your payment to the LCC office (Monday through Friday 9am-4:30pm) or drop it in a tithe envelope (be sure to label it as Friday MOPS payment). Please note: Payment of the deposit is needed to reserve your spot in Friday MOPS and your child(ren)'s place(s) in MOPS Kids.