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Moms Group 2017 Fall Registration
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* Indicates required question
Name
First Name
*
Your answer
Last Name
*
Your answer
Contact Information
Email Address
*
Your answer
Phone Number
*
Your answer
Address
Street
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Is CCOB your home church?
*
Yes
No
If you do not attend CCOB, what is your home church? (If any)
Your answer
Is this your first time attending Moms Group?
*
Yes
No
Moms Group Email Preferences
Would you like to begin receiving Moms Group emails? (e.g. meeting information, play date opportunities, encouragement, special events, etc.)
*
Yes
No
I currently am
Moms Group Service Opportunities
(optional)
I'd like to be a helper in childcare once or twice throughout the year.
I'm interested in providing a craft for the childcare servants to do with the kids once or twice a year.
I'd like to help with coffee set up.
I'm interested in helping plan play dates each month.
Attention Those Who are Volunteering as Children's Program Servants:
Please check here if you are registering your children only because you will be serving in childcare. Thank you!
Child Care Registration
Please only register your children that will be attending moms group.
Child 1
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/new walker)
1
2
3
4
5+
Registering for Children's Progam
Child 2
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/ new walker)
1
2
3
4
5+
Registering for Children's Program
Child 3
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/ new walker)
1
2
3
4
5+
Registering for Children's Program
Child 4
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/ new walker)
1
2
3
4
5+
Registering for Children's Program
Child 5
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/ new walker)
1
2
3
4
5+
Registering for Children's Program
Child 6
First Name
Your answer
Last Name
Your answer
Age
Choose
0-12 months (non-crawler)
0-12 months (crawler/ new walker)
1
2
3
4
5+
Registering for Children's Program
If Applicable
*Please list your child's name and any allergies that he or she may have. (No food will be served to the children).
Your answer
Comments: (If there is anything else you would like us to know.)
Your answer
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