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Wednesday Evenings Beginning This September



Phone:  Email: 

Number of preschool age children: 

Marital Status:

Married   Single   Divorced   Widowed 

Attended MOPS before:  Yes or  No   If yes, where? 




Name:   Age:   Date Of Birth: 


Name:   Age:   Date Of Birth: 


Name:   Age:   Date Of Birth: 


Name:   Age:   Date Of Birth: 


Will you bring your kids with you to MOPS meetings?  Yes   No   Sometimes 


If so, which kids? 


Do they already attend on Wednesday nights?  Yes    No    Sometimes 

How did you hear about First Assembly MOPS?

MOPS dues:

MOPS $30 due by September 4th, and $30 due by January 15th.     


Total MOPS Registration per year: $85  [Pay by cash, check or online!]        

            Make check payable to First Assembly Community Ministries (memo: MOPS)

            Online payments can be made at www.firstag.org/mops