Form

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	State
Zip Code	Country

How did you hear of VOG MOPS?
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

Full Year Registration Fee $ 80.00

First Semester Registration Fee $ 50.00

Total $ 0.00
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2017-2018 MOPS Vision of Glory Registration Form

MOPS Kids Childcare Information

Registration Fees