HARBORVIEW FELLOWSHIP MOPS 2017 â 2018 REGISTRATION
HARBORVIEW FELLOWSHIP MOPS 2017 – 2018 REGISTRATION (Return completed form to 4819 Hunt St. N.W. Gig Harbor, 98335)
Name: _______________________________________________ Date: ________________________ Address: ___________________________________________________________________________________ City/Zip: ___________________________________________________________________________________ Home Phone: _________________________________________ Cell: ________________________________ E-mail: _______________________________________________ Birth date: ___________________________ Church Affiliation: ___________________________________________________________________________ How did you hear about MOPS? ______________________________________________________________ MOPS is going green! May we notify you by email for correspondence?
Yes
No
___________________________________________________________________________________________
REGISTRATION FEES: Early Registration before June 15th Tuition.…………………………………………….....……………… $85_____ (This includes your MOPS International Free & your welcome package) After June 15th Tuition…………………………………………………………………………………..…... $95_____ 9/9/17 (prorated & due at registration if after 9/9/2017) OR Second Semester Only Jan-May ………………………………………………………...………………... $60_____ This includes your MOPS International Free & your welcome package (Prorated and due at registration) First Semester Optional Childcare/MOPPETS Registration For 1-2 children per semester………………………………………………….….…….. $40_____
For 3 or more children ….………………...……………………………………..……..... $60_____ Second Semester Optional Childcare/MOPPETS Registration For 1-2 children per semester ……………………………………………………...……. $40_____ For 3 or more children …………………...……………………………………………..... $60_____
Total ……………………………………..………………………………………….…..…….. $_______ § § § §
To maintain your MOPS registration, we kindly ask all fees be paid by the dates indicated above. Spots will not be reserved until the registration fee has been paid. Registration fees and tuition payments are non-refundable Registration fees are a one time per year fee payable upon registration Semester tuition will be prorated based upon time of registration
FOR GROUP USE ONLY Date registration received: _____________ Discussion Group assigned: _____________ Date registered for MOPS International Membership: _____________
HARBORVIEW FELLOWSHIP CHILDCARE // MOPPETS REGISTRATION
Mother’s name: ______________________________________________________________ Homes Phone: _________________________________ Cell: _________________________ Name
Gender
DOB
Allergies/Health Concerns
_________________ _________________ _________________ _________________ _________________
_______ _______ _______ _______ _______
______ ______ ______ ______ ______
___________________________ ___________________________ ___________________________ ___________________________ ___________________________
Pregnant? Due date _________________ Number of children if multiple birth ____________________ Please indicate any special circumstances regarding you child(ren) of which we could be aware:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________ Children not registered in childcare/MOPPETS Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ In effort to keep costs down, all moms with children registered in MOPPETS are required to fulfill 1 MOPPETS service commitment per semester. PHOTO AUTHORIZATION
Photos may be taken during MOPS/MOPPETS events for inclusion in Harborview Fellowship/ Harborview Fellowship MOPS publications or promotional materials. Please complete the following information for the children you are registering the MOPPETS (named above): I, _______________________________(parent of guardian) give my permission for my child(ren) (named above) to have his/her photo taken in Harborview Fellowship/Harborview Fellowship publications and promotional materials. Signature: ____________________________________________ Date: _________________
Name: _______________________________________________ Date: ________________________ Address: ___________________________________________________________________________________ City/Zip: ___________________________________________________________________________________ Home Phone: _________________________________________ Cell: ________________________________ E-mail: _______________________________________________ Birth date: ___________________________ Church Affiliation: ___________________________________________________________________________ How did you hear about MOPS? ______________________________________________________________ MOPS is going green! May we notify you by email for correspondence?
Yes
No
___________________________________________________________________________________________
REGISTRATION FEES: Early Registration before June 15th Tuition.…………………………………………….....……………… $85_____ (This includes your MOPS International Free & your welcome package) After June 15th Tuition…………………………………………………………………………………..…... $95_____ 9/9/17 (prorated & due at registration if after 9/9/2017) OR Second Semester Only Jan-May ………………………………………………………...………………... $60_____ This includes your MOPS International Free & your welcome package (Prorated and due at registration) First Semester Optional Childcare/MOPPETS Registration For 1-2 children per semester………………………………………………….….…….. $40_____
For 3 or more children ….………………...……………………………………..……..... $60_____ Second Semester Optional Childcare/MOPPETS Registration For 1-2 children per semester ……………………………………………………...……. $40_____ For 3 or more children …………………...……………………………………………..... $60_____
Total ……………………………………..………………………………………….…..…….. $_______ § § § §
To maintain your MOPS registration, we kindly ask all fees be paid by the dates indicated above. Spots will not be reserved until the registration fee has been paid. Registration fees and tuition payments are non-refundable Registration fees are a one time per year fee payable upon registration Semester tuition will be prorated based upon time of registration
FOR GROUP USE ONLY Date registration received: _____________ Discussion Group assigned: _____________ Date registered for MOPS International Membership: _____________
HARBORVIEW FELLOWSHIP CHILDCARE // MOPPETS REGISTRATION
Mother’s name: ______________________________________________________________ Homes Phone: _________________________________ Cell: _________________________ Name
Gender
DOB
Allergies/Health Concerns
_________________ _________________ _________________ _________________ _________________
_______ _______ _______ _______ _______
______ ______ ______ ______ ______
___________________________ ___________________________ ___________________________ ___________________________ ___________________________
Pregnant? Due date _________________ Number of children if multiple birth ____________________ Please indicate any special circumstances regarding you child(ren) of which we could be aware:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________ Children not registered in childcare/MOPPETS Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ Name: _______________________________________________ Date of Birth: __________________ In effort to keep costs down, all moms with children registered in MOPPETS are required to fulfill 1 MOPPETS service commitment per semester. PHOTO AUTHORIZATION
Photos may be taken during MOPS/MOPPETS events for inclusion in Harborview Fellowship/ Harborview Fellowship MOPS publications or promotional materials. Please complete the following information for the children you are registering the MOPPETS (named above): I, _______________________________(parent of guardian) give my permission for my child(ren) (named above) to have his/her photo taken in Harborview Fellowship/Harborview Fellowship publications and promotional materials. Signature: ____________________________________________ Date: _________________
