Essex Alliance MOPS Online Registration

Thank you for taking the time to register for the MOPS year online.  We hope that this process is easy for you.  Once we receive your registration, you should receive a confirmation e-mail.  If you don't hear from us, please feel free to contact Heather Clifford to confirm receipt of your registration.
Name:

Address:

City:

Zip:

Home Phone :

Birthday (month/day):

Years in MOPS:

Husband's Name:

or Are you a single mom?
  • Yes
  • No

E-mail Address:

Church Affiliation (if any):

How did you hear about MOPS?


If this is your first time to MOPS, who invited you?

Is your youngest child entering kindergarten this year?
  • Yes
  • No




YOUR KIDS
List the names & birth dates of all of your children. Indicate the ones you plan to enroll in MOPS childcare (MOPPETS) for the 2010-2011 MOPS season.

1. Child's Name
2. DOB (mm/dd/yy)
3. Enroll in MOPPETS? y/n
4. Any allergies that we should know about.

*If you are using the Tuesday PM childcare, do you plan on bringing your child/ren to every meeting?

  • Yes
  • No

Which MOPS meeting do you plan to attend?

New lower prices for MOPS this year!!!! Please mark the plan you plan to use below:

MOPS REGISTRATION
  • Plan 1 (two free meetings*): $24.00 online or at MOPS in Sept. 2010, $6/meeting
  • Plan 2 (9% discount save $10): $52 online or at MOPS in Sept. 2010, $52.00 online or at MOPS in Jan. 2011
  • Plan 3 (15% discount save $17): $97.00 online or at MOPS in Sept. 2010

*Your first meeting and Spa Day are free. Discount is based on paying Plan 1 prices for the full year.



SCHOLARSHIPS


If the registration/dues presents a financial hardship, please ask someone on the Finance Team for a scholarship form or contact Amy Carnesale the Finance Coordinator 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 choose to make this donation online after you submit the registration form.)

  • $97.00 (a year)
  • $52 (a semester)
  • $24 (registration)
  • Other





SERVICE OPPORTUNITIES

The MOPS leadership team provides a special opportunity for service and growth. Make your MOPS experience even more rewarding by getting involved!

Please check off the committee where you might like to serve so that someone can contact you.
  • Special Events
  • Care Team
  • Creative Activities
  • Finance
  • Hospitality
  • Publicity
  • MOPPETS

DIRECTORY

We would like to produce a directory of Essex Alliance MOPS moms, to be distributed only within our MOPS group. We also wish to honor your desire for privacy. Inclusion in the directory is completely optional.
Please indicate your level of involvement using the 2 choices below:

  • 1. Please do not include any of my personal information in the directory
  • 2. Yes, please include any of my information in the directory. (e.g. name, phone, e-mail, address, meeting I attend, or my children's names and ages)

PICTURES

Pictures may be taken during MOPS meetings or events that may be used in publications or on the Essex Alliance MOPS website.
Please check if you would not like to have your picture used for these purposes.

  • Do not use pictures of me.



PAYMENT

Please let us know how you plan to pay for your MOPS Meetings
  • Credit Card - You can choose to pay online after you submit this registration.
  • Check - Please make your check payable to Essex Alliance Church and include "MOPS fee" on the memo line.
  • Cash

Thank you for taking the time to fill out this form. Enjoy your MOPS experience!