Highlands Mom 2 Mom Registration Form
Please fill out all the information completely!
Full Name *
Your answer
Primary Contact Number *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
Church home?
Your answer
Are you coming with a friend?
Please put the name of your friend.
Your answer
Child 1 name in need of childcare
Your answer
Child 1 birthdate
MM
/
DD
/
YYYY
Child 1 allergies or special needs
Your answer
Child 2 name in need of childcare
Your answer
Child 2 birthdate
MM
/
DD
/
YYYY
Child 2 allergies or special needs
Your answer
Child 3 name in need of child care
Your answer
Child 3 birthdate
MM
/
DD
/
YYYY
Child 3 allergies or special needs
Your answer
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