Registration Form

Online Registration


Thank you for registering online for the MOPS 2016-2017 year.

If you have any questions about the registration process or about the function of this form or the website, please contact Amy Carnesale. Thank you!

GENERAL INFORMATION

Name:
Address:
City:
Zip:
Home Phone :
E-mail Address:
Birthday (month/day):
Number of years you have attended MOPS:
Are you a single mom?
  • Yes
  • No
Husband's Name (if applicable):
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 CHILDREN:

Please list the names & birth dates of all of your children. Indicate the ones you plan to enroll in MOPS morning childcare (MOPPETS). 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: MOPPETS?
4. Allergies? If yes, please list.

MEETING SELECTION AND FINANCE INFORMATION

Which MOPS meeting do you plan to attend?
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: $25 due Sept. 2016 (includes $25 registration fee; $5 due at each mtg)
  • MORNING MTG. PLAN 2 - Pay twice a year: $40 due Sept. 2016 & Jan. 2017 (includes $25 registration fee & mtg fees; 1 Free mtg.)
  • MORNING MTG. PLAN 3 - Pay yearly: $75 due Sept. 2016 (includes $25 registration fee & mtg fees; 2 Free mtgs.)
  • EVENING MTG. PLAN 1 - Pay as you go: $25 due Sept. 2016 (includes $25 registration fee; $5 due at each mtg)
  • EVENING MTG. PLAN 2 - Pay twice a year: $45 due Sept. 2016 & Jan. 2017 (includes $25 registration fee & mtg fees; 1 Free mtg.)
  • EVENING MTG. PLAN 3 - Pay Yearly: $85 due Sept. 2016 (includes $25 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 Amy Carnesale, the MOPS 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 $85, $75, $45, $40, $25 or any other amount. (You can make this donation online after you submit the registration form.)

  • 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.
  • Special Events
  • Care Team
  • Creative Activities
  • Finance
  • Hospitality
  • Publicity
  • MOPPETS

PICTURES

Pictures may be taken during MOPS meetings or events, or in MOPPETS, 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!