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MOPS Registration Form 2017-2018
Welcome to MOPS! We will meet the 1st and 3rd Tuesday of the month, September - April.
Hosted by Iowa City First Assembly of God
1330 Keokuk St. Iowa City, IA 52240
Cost is $70 for the year, which pays for national MOPs registration, childcare, and hospitality expenses
Your Information
First Name *
Your answer
Last Name *
Your answer
Preferred Phone *
Your answer
Address *
Your answer
Birthday *
MM
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DD
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YYYY
Email Address *
Your answer
Have you attended a MOPS group before?
Do you attend a church?
If so, where?
Your answer
Please list any food allergies.
Your answer
MOPPETS
There will be a program for children 0-5, children above the age of 5 may attend as helpers. If you have more than 4 children please contact the email address on this form with the additional names and information.
1st Child's Name Attending MOPPETS
Your answer
Child's Birthdate
MM
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DD
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YYYY
2nd Child's Name Attending MOPPETS
Your answer
Special Needs/Allergies
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Special Needs/Allergies
Your answer
3rd Child's Name Attending MOPPETS
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Special Needs/Allergies
Your answer
4th Child's Name Attending MOPPETS
Your answer
Special Needs/Allergies
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Special Needs/Allergies
Your answer
Registration & Payment
MOPS registration will be open throughout the year, payment will be due upon registration.
Payment Method for annual fee of $70 *
Our Information
Iowa City First Assembly of God
1330 Keokuk St. Iowa City, IA 52240
319-853-8664
www.iowacityfirst.org
firstladyholly.iowacityfirst@gmail.com
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