2017-2018 MOPS Vision of Glory Registration Form
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How did you hear of VOG MOPS?
Current MOPS Member
Regular attendee of VOG
New to MOPS
Website
Other
Home Church (if applicable)
MOPS Kids Childcare Information
MOPS is designed for mothers of children ages birth through kindergarten. We meet during the school year from September-December (First Semester) and January-May (Second Semester) from 9:30am-11:30am.
Number of children requiring childcare through MOPS Kids
*
Childcare is for children from newborn to kindergarten.
First Child
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Any special needs or allergies? Please tell us about them here.
Second Child
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Any special needs or allergies? Please tell us about them here.
Third Child
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Any special needs or allergies? Please tell us about them here.
Please check the appropriate boxes below to give MOPS child care workers permission to assist your child with the following (all MOPS child care workers are required to pass a background check). I give permission, when necessary, for one MOPS adult or junior worker to:
Change my child's diaper under the Nursery Guidelines for care and hygiene.
*
Yes
No
Escort my child to the restroom. I understand that my child should be capable of independently caring for his/her bathroom needs and, if requested, the worker may assist with basic tasks of care and hygiene.
*
Yes
No
As a participant of MOPS and a parent/guardian of the child(ren) listed above, I give permission to VOG to publish for its own use any pictures of myself or my child taken during this program.
*
Yes
No
Registration Fees
With each registration, you will receive a MOPS International welcome kit including a "Free Indeed" guidebook, some adorable postcards to spread some love to other moms, a small jewelry item that matches the year's theme, an annual subscription to "Hello, Dearest" magazine and weekly emails with Godly inspiration.
Registration is $80 for the year or $50 for the first semester.
Registration Payment
*
Cash or Check (bring to 1st meeting in Sept)
Credit Card via PayPal (select option below)
Registration Type
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Full Year Registration Fee
$80.00
$
80.00
First Semester Registration Fee
$50.00
$
50.00
Total
$0.00
$
0.00
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