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Essex Alliance Church
:
MOPS
:
Registration Form
Registration Form
Online Registration
Thank you for registering online for the MOPS 2017-2018 year.
If you have any questions about the registration process or about the function of this form or the website, please contact
Brianne Danaher
. Thank you!
GENERAL INFORMATION
Name:
Address:
City:
Zip:
Phone:
E-mail Address:
Birthday (month/day):
Number of years you have attended MOPS:
Choose...
0
1
2
3
4
5
6
7
8
9
10
Other
Are you a single mom?
Yes
No
Partner's Name (if applicable):
Home Church (if applicable):
How did you hear about MOPS?
Choose...
Essex Alliance Church
Friend
Neighbor
Another Mom
Other
If this is your first time to MOPS, who invited you?
Is your youngest child entering kindergarten this year?
Yes
No
.
YOUR CHILDREN:
Please list the names & birth dates of all of your children. Indicate the ones you plan to enroll in MOPS morning childcare (MOPS Kids). Unfortunately, evening childcare is not available at this time.
Please list for all children:
1. Child's Name (first & last)
2. DOB (mm/dd/yy)
3. Enroll in: MOPS Kids?
4. Allergies? If yes, please list.
MEETING SELECTION AND FINANCE INFORMATION
Which MOPS meeting do you plan to attend?
Choose...
Monday PM
Tuesday AM
Which registration option would you like to choose?
*Discount is based on paying Plan 1 prices for the full year.
MORNING MTG. PLAN 1 - Pay as you go: $32 due Sept. 2017 (includes $32 registration fee; $5 due at each mtg)
MORNING MTG. PLAN 2 - Pay twice a year: $46 due Sept. 2017 & Jan. 2018 (includes $32 registration fee & mtg fees; 1 Free mtg.)
MORNING MTG. PLAN 3 - Pay yearly: $87 due Sept. 2017 (includes $32 registration fee & mtg fees; 2 Free mtgs.)
EVENING MTG. PLAN 1 - Pay as you go: $32 due Sept. 2017 (includes $32 registration fee; $5 due at each mtg)
EVENING MTG. PLAN 2 - Pay twice a year: $51 due Sept. 2017 & Jan. 2018 (includes $32 registration fee & mtg fees; 1 Free mtg.)
EVENING MTG. PLAN 3 - Pay Yearly: $97 due Sept. 2017 (includes $32 registration fee & mtg fees; 2 Free meetings)
Please indicate how you would like to pay for your registration and/or dues: Please plan to pay at your first meeting
CHECK (Please make check payable to Essex Alliance Church with "MOPS" on the memo line)
CASH
Credit/Debit Card
SCHOLARSHIPS
If the registration fee or dues present a financial hardship, please check the box below. You may also ask a member of the Finance Team or contact
Brianne Danaher
, the Finance Coordinator, for a scholarship form or for more information. Please do not let cost in any way influence your decision.
I would like to apply for a Scholarship
SPONSORING A MOPS MOM
Interested in sponsoring another MOPS mom? You can sponsor amounts of $87, $32, or any other amount. You can make a donation by card, check, or cash at a meeting.
Yes
No
SERVICE OPPORTUNITIES
The MOPS leadership team provides a special opportunity for service and growth. Make your MOPS experience even more rewarding by getting involved!
Select any committee(s) on which you might like to serve so that someone can contact you.
Hospitality
MOPS Kids
Care Team
Creative Activities
Finance
Publicity
Special Events
PICTURES
Pictures may be taken during MOPS meetings or events, or in MOPS Kids, that may be used in publications or on the Essex Alliance MOPS website.
Please check below if you would
not
like to have your picture or your child(ren)'s pictures used for these purposes.
Do not use pictures of me.
Do not use pictures of my child(ren).
Thank you for taking the time to fill out this form. Enjoy your MOPS experience!
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