MOPS Kids Registration
We love MOPS Kids! Our goal is take excellent care of them while
you enjoy your time with other moms. Help us get to know you and your
child! You can update your information at any time – just talk to your
MOPS Kids leader.

Please fill out this form individually for each child that will be attending MOPS Kids. For families with multiple children please COMPLETELY fill the form ONCE and then additional children with SAME LAST NAME only need the required fields entered.
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Child's Information:
Child's First Name *
Child's Last Name *
Child's Birthdate: *
MM
/
DD
/
YYYY
Parent's Information:
Mother's Full Name: *
Mother's Cell Phone Number:
Mother's Birthdate:
MM
/
DD
/
YYYY
Father's Full Name:
Father's Cell Phone Number:
Father's Birthdate:
MM
/
DD
/
YYYY
Email Address:
Mailing Address:
Who has permission to pick up your child(ren) from MOPS Kids?
Person #1 Full Name: *
Person #1 Relationship: *
Person #1 Phone Number:
Person #2 Full Name:
Person #2 Relationship:
Person #2 Phone Number:
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