River West - MOPS (Mother's of Preschoolers)
MOPS Registration 2017-2018
Welcome! Please complete this form so we can learn about you!

River West Group Fees for 2017-2018
• Mom Only (No childcare required*) - $150/year
• Mom and 1 Child - $225/year
• Mom and 2 Children - $315/year
• Mom and 3-4 Children - $360/year

*Children under 6 months are considered lap babies and do not require childcare. Once a child is 6 months we are required to hold a spot for them in care and will charge childcare fees.
*You can pay semi-annually (September & January) with post-dated cheques (due at start of MOPS), or all at once (cash or cheque). Please make all cheques payable to River West Christian Church.

For more information please contact the church office office@riverwestchurch.org or 780-487-2275

Your Contact Information
First Name *
Your answer
Last Name *
Your answer
Home Phone *
Your answer
Alternate Phone
Your answer
Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Email *
Your answer
Birthday
MM
/
DD
Your MOPS Information
Have you attended a MOPS group before? *
If "Yes", Where?
Your answer
Home Church
Your answer
How did you hear about this MOPS group?
Your answer
Your Family Information
Please List Your child(ren)'s name(s) and birthdate(s) & Gender: *
Your answer
Husband's name (if applicable)
Your answer
Does your child(ren) have any medical conditions or allergies?
If "yes" please list child and condition
Your answer
Is there anyone that DOES NOT have permission to pick up your child (i.e. custody situation)? If so, please provide their name
Your answer
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