MOPS Registration Form 2017-18
Thank you for your interest in MOPS and MOMSnext at Intrepid Christian Church! You will find our registration form attached. Registration can also be completed on our website at: www.intrepid.church/groups/mops. Please complete a registration form for yourself, and a MOPS KIDS registration form for your child(ren). Return completed forms and dues to: Intrepid Christian Church MOPS 5500 Olympic Drive. Ste. H-105 PMB #236 Gig Harbor, WA 98335 For questions, contact: 253.432.4655 or email [email protected]
2017-18 MOPS International
REGISTRATION FORM
YOUR MOPS INFO
YOUR CONTACT INFO
W E LC O M E ! P L E A S E C O M P L E T E T H I S F O R M S O W E C A N L E A R N A B O U T YO U !
Last Name: ________________________________________________ First Name: _______________________________________________ M.I.: ______ Home Phone: __________________________________________________ Alternate Phone: __________________________________________________ Address: ______________________________________________________________________________________________________________________________ City: _________________________________________________________________________ State: ___________ Zip Code: _________________________ Email: _______________________________________________________________________________ Birthday: ______________________________________
Name of MOPS Group: ______________________________________________________________________________________ Have you attended a MOPS group before?
Yes
No If yes, where? _____________________________________________
Are you already registered for the MOPS International Membership?
Yes
No
Home church (if applicable): _________________________________________________________________________________ How did you hear about this MOPS group? _____________________________________________________________________
YOUR FAMILY INFO
PLEASE LIST YOUR CHILD(REN)’S NAME(S) AND BIRTHDATE(S): Name: ____________________________________________________________________________________________________ Date of Birth: _____________________________________________________________________________________________ Name: ____________________________________________________________________________________________________ Date of Birth: _____________________________________________________________________________________________ Name: ____________________________________________________________________________________________________ Date of Birth: ______________________________________________________________________________________________ Husband’s Name (if applicable): ______________________________________________________________________________
MOPS Membership Fee ........................................................................................................................................................................... $31.95 must....................................................................................................................................................... register themselves online at www.mops.org/join using the code WR08 to connect to Membership $29.95 per year 2 years of Members MOPS and MOMSnext at Intrepid 3 years of Membership ..................................................................................................................... $27.95 per year (that’s a 13% savings!) You will receive a Welcome Kit and The MOPS Magazine from MOPS International MOPS Mentor Membership Fee (Mentors only) ................................................................................................................................. $33.95 You will receive a Welcome Kit and The MOPS Magazine from MOPS International
Early Registration! Save $2 on Membership if you register by May 31, 2017 ................................................... $ ___________ 60.00 Group Fee ................................................................................................................................................................................... $ ___________ TOTAL ........................................................................................................................................................................................... $ ___________ * FOR GROUP USE ONLY
Name of MOPS Group: ___________________________________________________________________________________ Date Registration Received: _____________________________________________________________________________ Discussion Group Assigned: _____________________________________________________________________________ Date Registered for MOPS International Membership: _________________________________________________
MOPS Kids Registration We love MOPS Kids! Our goal is take excellent care of them while you enjoy your time with other moms. We will engage with stories, songs, and age-appropriate play. Help us get to know you and your child! You can update your information at any time – just talk to your MOPS Kids leader.
Child’s Information: Child’s Last Name: Child’s First Name: Child’s Birthdate: Parent’s Information: Mom’s Full Name: Mom’s Cell Number:
Mom’s Birthday:
Father’s Full Name: Father’s Cell Number: Other Phone Number:
Father’s Birtrhday:
Email Address: Address: Who has permission to pick up your child(ren) from MOPS Kids? Person 1:
Person 2:
Name: Relationship: Phone Number: Additional Emergency Contacts: Contact 1: Name: Relationship: Phone Number:
Contact 2:
Special needs or instructions
Allergies: Other Siblings names: Favorite toys, songs, games, snacks, etc: What else would you like us to know about you, your child or your family? Family Doctor: Doctor’s Name: Phone: Address:
For MOPS Kids Leader Use. MOPS Kids Room Assignment:
DUES INFORMATION: Fall Semester (Sept. – Jan.) Tuition: Spring Semester (Feb. – May) Tuition: Annual Tuition (Sept.-May)
$30.00 $30.00
Due at time of registration to secure your spot Due in January
$60.00
$5 off if you pay by June 1st for the year in advance To reserve childcare for 1-2 children in MOPS KIDS To reserve childcare for 1-2 children in MOPS KIDS
Fall Childcare Cost:
$45.00
Spring Childcare Cost:
$45.00
Make checks payable to: Intrepid Christian Church, and write MOPS in the memo line. Please Note: • Your registration and MOPS KIDS placement for your children is complete when applications AND fees are received • An annual MOPS International Registration Fee of $31.95 is the responsibility of each mom to pay directly to MOPS International by visiting www.mops.org/join and using the 4-digit Quick Registration Code WR08. This registration provides you with numerous MOPS International resources and gifts, and also provides a way for you to support MOPS Ministries and care of other Moms around the world (see www.mops.org for more info). • The per-semester childcare cost is for 1-2 children. For each additional child, the childcare cost is $20/semester. • Refund policy: Due to Meeting Planning, no refunds will be given for the Fall Semester. If you pay for the entire year in advance ($60), up to $30 of your Spring Semester fees may be refunded if your registration is cancelled by 12/12/17. Due to planning purposes, we are not able to give refunds for the Spring Semester after this date. Please read the following and Initial here: __________________ I have read the above MOPS fee payment information. I understand that in order to maintain my MOPS registration, my registration fees and semester tuitions must be submitted according to the above schedule.
MOPS KIDS SERVICE COMMITMENT: In an effort to keep childcare costs as low as possible, we ask Moms with children registered in MOPS KIDS to sign up for one hour (half a meeting) per semester in a MOPS KIDS classroom. Sign-ups will take place at the first meeting of each semester. PHOTO AUTHORIZATION Photos may be taken during MOPS/MOPS KIDS events for inclusion in Intrepid/Intrepid MOPS publications or promotional materials. Please complete the following information for the children you are registering in MOPS KIDS: I, _______________________________________ (parent or guardian), give my permission for my child(ren): _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ to have his/her photo taken and included in Intrepid/Intrepid MOPS publications or promotional materials. I also give permission for my photo to be taken for use in Intrepid/Intrepid MOPS publications or promotional materials. Signature: __________________________________________________ Date: _________________________
2017-18 MOPS International
REGISTRATION FORM
YOUR MOPS INFO
YOUR CONTACT INFO
W E LC O M E ! P L E A S E C O M P L E T E T H I S F O R M S O W E C A N L E A R N A B O U T YO U !
Last Name: ________________________________________________ First Name: _______________________________________________ M.I.: ______ Home Phone: __________________________________________________ Alternate Phone: __________________________________________________ Address: ______________________________________________________________________________________________________________________________ City: _________________________________________________________________________ State: ___________ Zip Code: _________________________ Email: _______________________________________________________________________________ Birthday: ______________________________________
Name of MOPS Group: ______________________________________________________________________________________ Have you attended a MOPS group before?
Yes
No If yes, where? _____________________________________________
Are you already registered for the MOPS International Membership?
Yes
No
Home church (if applicable): _________________________________________________________________________________ How did you hear about this MOPS group? _____________________________________________________________________
YOUR FAMILY INFO
PLEASE LIST YOUR CHILD(REN)’S NAME(S) AND BIRTHDATE(S): Name: ____________________________________________________________________________________________________ Date of Birth: _____________________________________________________________________________________________ Name: ____________________________________________________________________________________________________ Date of Birth: _____________________________________________________________________________________________ Name: ____________________________________________________________________________________________________ Date of Birth: ______________________________________________________________________________________________ Husband’s Name (if applicable): ______________________________________________________________________________
MOPS Membership Fee ........................................................................................................................................................................... $31.95 must....................................................................................................................................................... register themselves online at www.mops.org/join using the code WR08 to connect to Membership $29.95 per year 2 years of Members MOPS and MOMSnext at Intrepid 3 years of Membership ..................................................................................................................... $27.95 per year (that’s a 13% savings!) You will receive a Welcome Kit and The MOPS Magazine from MOPS International MOPS Mentor Membership Fee (Mentors only) ................................................................................................................................. $33.95 You will receive a Welcome Kit and The MOPS Magazine from MOPS International
Early Registration! Save $2 on Membership if you register by May 31, 2017 ................................................... $ ___________ 60.00 Group Fee ................................................................................................................................................................................... $ ___________ TOTAL ........................................................................................................................................................................................... $ ___________ * FOR GROUP USE ONLY
Name of MOPS Group: ___________________________________________________________________________________ Date Registration Received: _____________________________________________________________________________ Discussion Group Assigned: _____________________________________________________________________________ Date Registered for MOPS International Membership: _________________________________________________
MOPS Kids Registration We love MOPS Kids! Our goal is take excellent care of them while you enjoy your time with other moms. We will engage with stories, songs, and age-appropriate play. Help us get to know you and your child! You can update your information at any time – just talk to your MOPS Kids leader.
Child’s Information: Child’s Last Name: Child’s First Name: Child’s Birthdate: Parent’s Information: Mom’s Full Name: Mom’s Cell Number:
Mom’s Birthday:
Father’s Full Name: Father’s Cell Number: Other Phone Number:
Father’s Birtrhday:
Email Address: Address: Who has permission to pick up your child(ren) from MOPS Kids? Person 1:
Person 2:
Name: Relationship: Phone Number: Additional Emergency Contacts: Contact 1: Name: Relationship: Phone Number:
Contact 2:
Special needs or instructions
Allergies: Other Siblings names: Favorite toys, songs, games, snacks, etc: What else would you like us to know about you, your child or your family? Family Doctor: Doctor’s Name: Phone: Address:
For MOPS Kids Leader Use. MOPS Kids Room Assignment:
DUES INFORMATION: Fall Semester (Sept. – Jan.) Tuition: Spring Semester (Feb. – May) Tuition: Annual Tuition (Sept.-May)
$30.00 $30.00
Due at time of registration to secure your spot Due in January
$60.00
$5 off if you pay by June 1st for the year in advance To reserve childcare for 1-2 children in MOPS KIDS To reserve childcare for 1-2 children in MOPS KIDS
Fall Childcare Cost:
$45.00
Spring Childcare Cost:
$45.00
Make checks payable to: Intrepid Christian Church, and write MOPS in the memo line. Please Note: • Your registration and MOPS KIDS placement for your children is complete when applications AND fees are received • An annual MOPS International Registration Fee of $31.95 is the responsibility of each mom to pay directly to MOPS International by visiting www.mops.org/join and using the 4-digit Quick Registration Code WR08. This registration provides you with numerous MOPS International resources and gifts, and also provides a way for you to support MOPS Ministries and care of other Moms around the world (see www.mops.org for more info). • The per-semester childcare cost is for 1-2 children. For each additional child, the childcare cost is $20/semester. • Refund policy: Due to Meeting Planning, no refunds will be given for the Fall Semester. If you pay for the entire year in advance ($60), up to $30 of your Spring Semester fees may be refunded if your registration is cancelled by 12/12/17. Due to planning purposes, we are not able to give refunds for the Spring Semester after this date. Please read the following and Initial here: __________________ I have read the above MOPS fee payment information. I understand that in order to maintain my MOPS registration, my registration fees and semester tuitions must be submitted according to the above schedule.
MOPS KIDS SERVICE COMMITMENT: In an effort to keep childcare costs as low as possible, we ask Moms with children registered in MOPS KIDS to sign up for one hour (half a meeting) per semester in a MOPS KIDS classroom. Sign-ups will take place at the first meeting of each semester. PHOTO AUTHORIZATION Photos may be taken during MOPS/MOPS KIDS events for inclusion in Intrepid/Intrepid MOPS publications or promotional materials. Please complete the following information for the children you are registering in MOPS KIDS: I, _______________________________________ (parent or guardian), give my permission for my child(ren): _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ to have his/her photo taken and included in Intrepid/Intrepid MOPS publications or promotional materials. I also give permission for my photo to be taken for use in Intrepid/Intrepid MOPS publications or promotional materials. Signature: __________________________________________________ Date: _________________________
