Uptown MOPS Kid Registration Form
Please complete one form for each child participating in the Uptown MOPS program.
Child's Name *
Your answer
Mother's Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Does your child have any allergies or restrictions that we should be aware of? *
Your answer
Typically, we provide a snack for the children. Does your child have any restrictions that we should be aware of? *
Your answer
If a picture is taken of you &/or your children at a MOPS event, do we have your permission to share it on our blog or Facebook page? *
Submit
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