MOPS/MOMSnext Registration
Use this form to register to participate in our MOPS Bible study for the 2019-2020 school year.
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Primary Contact # *
Your answer
Date of Birth (MM/DD/YYYY) *
MM
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DD
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YYYY
Number of Children *
CHILDCARE INFORMATION-Please enter each child's information below for childcare. Please include child's name and date of birth (mm/dd/yyyy). Enter "none" if you do not require childcare. *
Your answer
MEDICAL CONDITIONS, ALLERGIES OR SPECIAL NEEDS (PLEASE BE SPECIFIC) Please list any medical conditions, allergies or special needs we should be aware of for you or your children.
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Emergency Contact Name & Cell Phone #
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Please enter the amount due (cost is $80 per mom, no children; $120 per mom +1 child in childcare; add an additional $10 per child if more children will be in childcare). *
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Registration is not complete until payment is received. Copy and paste this hyperlink to pay: https://sglogin.com/christchurchlutheran/modules/donorHub/
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