***WAIT LIST**** Moms of Young Children
Registration 2017-2018 is currently full, but please register and we will add you to our wait list! As changes are made or more childcare workers are available, you will be notified by email!!
Name
Your answer
Address
Your answer
Phone number
Your answer
Email address
Your answer
Preferred method of contact
Emergency contact name and phone number
Your answer
Have you previously attended MYC (formerly MOPS)?
What is your home church (if applicable)?
Your answer
How did you hear about this MYC group?
Your answer
Child's name and birth date
Your answer
Child's name and birth date
Your answer
Child's name and birth date
Your answer
Child's name and birth date
Your answer
Child's name and birth date
Your answer
Do any of your children have food/medical allergies? Any other information that would be helpful in placing your child in a class?
Your answer
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