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First Assembly MOPS Registration 2014-2015
Name:  

Street Address: 

City   Zip Code: 
Phone:  Email: 

Do you have Facebook?   Yes  No   Date of Birth:

Preferred Method of contact?  Call      Text       Email       Facebook 


Marital Status:

Married   Single   Divorced   Widowed 
Husband’s Name (if applicable): 

Do you work outside the home?    Full-Time      Part-Time           Stay-At-Home 

Do you have a home church?  Yes   No 
If so, where : 

 If this is your first year with First Assembly MOPS: 

 How did you hear about our group? 

Have you attended MOPS before:  Yes  or  No

If yes, where? 

Children:

 

First and Last Name:   Age:  

Date Of Birth:  Gender: M  or F    

Attending Childcare: Yes   No 

 Allergies/Special Instruction:

 

First and Last Name:   Age:  

Date Of Birth:  Gender: M  or F    

Attending Childcare: Yes   No 

 Allergies/Special Instruction:

 

First and Last Name:   Age:  

Date Of Birth:  Gender: M  or F    

Attending Childcare: Yes   No 

 Allergies/Special Instruction:

 

First and Last Name:   Age:  

Date Of Birth:  Gender: M  or F    

Attending Childcare: Yes   No 

 Allergies/Special Instruction:

 

Please check any of the following that interest you:

Hosting a Play Date at your home                 Serving as a Greeter 

Hosting a Mom’s Night Out at your home     Assisting with Set-Up 

Assisting with Clean-Up                                Creative Activities 

Serving in child care (as needed)                      Planning Special Events  

Assisting with Fund Raising 

    MOPS Payment Plan:

 MOPS International fee $25 (Due at Registration)

 $60 for 1st and 2nd Semester Dues (Due by Sept. 17th)

   $30 for 1st Semester (Due Sept. 17th, Remaining $30 due by Jan. 21st)

 Please contact me about scholarship or alternate payment plans.                          Thank you so much for registering for the 2014-2015 MOPS year! In order to complete the registration process and ensure that we will hold a spot for you, the deposit of $25.00 must be submitted.

[Pay by cash, check or online!]        

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

            Online payments can be made here!    
Registration Questions? Contact Misty Thompson.