2018-2019 MOPS @ Saint Paul's Registration
Please complete all fields and make a check payable to Saint Paul's MOPS and return to the membership chair, Jennifer Kern, or finance chair, Amanda Haskin. Dues for 2018-2019 are $110.00. You may also send via Paypal to saintpaulsmops@gmail.com.
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First Name *
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Last Name *
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Email *
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Address *
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City *
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State *
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Zip Code *
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Home Phone
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Mobile Phone *
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What is the best way to contact you? *
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If Other, please describe:
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Birthdate *
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Your Facebook login (if not your name)
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Husband's name (If applicable)
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How did you hear about us? *
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Child 1 Name *
Your answer
Child 1 DOB *
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Does Child 1 need MOPS Kids (childcare)? *
Child 2 Name
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Child 2 DOB
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YYYY
Does Child 2 need MOPS Kids (childcare)?
Child 3 Name
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Child 3 DOB
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Does Child 3 need MOPS Kids (childcare)?
Child 4 Name
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Child 4 DOB
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Does Child 4 need MOPS Kids (childcare)?
Please include ALL allergy information for your child/ren *
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Who has permission to pick up your children in case of emergency (name and phone number)? *
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Additional emergency contact (name and number please)
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Family Doctor
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How would you like to pay the Saint Paul's MOPS group fee of $110? (There is also an International Fee of $31.95 that is INCLUDED.) *
Anything else we need to know?
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