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Westminster 2019-2020 MOPS Registration Form
Welcome to MOPS! Please complete this form so we can learn more about you and your children.

PLEASE NOTE: Your registration is not complete, nor is your spot reserved in MOPPETS until the MOPS International Fee is received.

You may make an online payment at http://www.westminstermops.com/registrationandpayment.htm
Personal Information
First Name *
Your answer
Last Name *
Your answer
Phone Number
000-000-0000
Your answer
Address *
Your answer
Email *
Your answer
Are you on Facebook? *
Would you like to be part of our Facebook Group? *
We use Facebook as a main communication tool.
What is your preferred contact method? *
Choose all that apply
Required
Birthdate *
MM
/
DD
Occupation
Your answer
Spouse's Name
Your answer
Spouse's Occupation
Your answer
Home Church, if applicable
Your answer
Emergency Contact *
Your answer
CHILDREN INFORMATION
Please tell us about your children and indicate if they will be attending Moppets.

Our Moppets program provides childcare for infant through kindergarten during MOPS meetings. Children under 6 months are allowed in the meeting.
Child 1: First and Last Name *
Your answer
Child 1: Birthdate *
MM
/
DD
/
YYYY
Child 1: Age *
Your answer
Child 1: Does Child Have a Food Allergy *
Child 1: Attending MOPPETS? *
Child 2: First and Last Name
Your answer
Child 2: Birthdate
MM
/
DD
/
YYYY
Child 2: Age
Your answer
Does Child Have a Food Allergy
Child 2: Attending MOPPETS?
Child 3: First and Last Name
Your answer
Child 3: Birthdate
MM
/
DD
/
YYYY
Child 3: Age
Your answer
Does Child Have a Food Allergy
Child 3: Attending MOPPETS?
Child 4: First and Last Name
Your answer
Child 4: Birthdate
MM
/
DD
/
YYYY
Child 4: Age
Your answer
Does Child Have a Food Allergy
Child 4: Attending MOPPETS?
Child 5: First and Last Name
Your answer
Child 5: Attending MOPPETS?
Child 5: Birthdate
MM
/
DD
/
YYYY
Child 5: Age
Your answer
Does Child Have a Food Allergy
Child 6: First and Last Name
Your answer
Child 6: Birthdate
MM
/
DD
/
YYYY
Child 6: Age
Your answer
Does Child Have a Food Allergy
Child 6: Attending MOPPETS?
MENTOR MOM INFORMATION
If you are serving as a Mentor MOM please indicate below.
Are you serving as a Mentor Mom?
Which Payment option would you prefer for your Westminster MOPS Fee? *
MOPS FEE AND SCHOLARSHIP INFORMATION
MOPS International Fee: $30.00
Westminster MOPS Fee WITH Moppets: $110.00 ($140 Total with MOPS Int'l Fee)
Westminster MOPS Fee WITHOUT Moppets: $65.00 ($95 Total with MOPS Int'l Fee)

We do not want any Mom to feel like she cannot attend MOPS due to financial constraints. We have several fundraising opportunities to help with tuition. Scholarships are available. Please return the completed Scholarship Form, included in your registration packet, and return to Meagan Holm.

Your registration is not complete, nor is your spot reserved in MOPPETS until the MOPS International Fee is received.

We accept credit card and PayPal payment on our website: http://www.westminstermops.com/registrationandpayment.htm

You may also send a check made payable to Westminster MOPS

Westminster Presbyterian Church
attn: MOPS
1012 Soo San Dr.
Rapid City, SD 57702

MOPS Questions
Have you attended a MOPS group before? If yes, where?
Your answer
Are you interested in helping the MOPS Leadership Team? *
MOPS is organized by various volunteers teams. Whether it is helping set up for a meeting, heading up a special event, or assisting with a fundraiser, volunteering is a great way to connect and support MOPS. We want to put your talents to work!
If yes, which Leadership Team(s)/Events are you interested in?
What are the top two things you hope to get out of attending MOPS?
Your answer
How did you learn about Westminster MOPS?
We occasionally use photos taken during our meetings on our social media platforms, for promotional purposes, as well as through MOPS International. Please select "Yes" if you agree to the use of your photo and "No" if you would not like your photo posted or used in any way. *
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