mops registration form
LAKESIDE MOPS/MOMS Next REGISTRATION FORM 2015-2016 Name: Address: City: Hm Phone:
Zip: Cell Phone:
Text: Y/N
Email: Birth Date:
Age:
Spouse
NEW for 2015! Please check the group you would like to join: _____MOPS (moms of children birth-kindergarten) _____MOMS Next (must have at least one school-aged child)
Prior MOPS Member? Yes/No
How did you hear about MOPS?
Do you attend church? Yes/ No If so, where? Please list your child/children’s names and birth date of those who will attend MOPPETS: NAME DOB Male/Female Allergies 1. 2. 3.
Registration Fee: $20. Membership Fee: $50 each for fall and spring semesters ($120 total. Payments can be paid in full or at the beginning of each semester) Enclosed (check all that apply): $20 registration (required to reserve spot) $50 for fall semester $50 for spring semester □ I’d like to donate a scholarship to help another mom. □ I need more information on receiving a scholarship. Note: Number of available scholarships is limited. Scholarships cover our MOPS group expenses.
Payment: Make checks payable to LBC/MOPS Mail your check, MOPS registration form & MOPPETS registration form(s) to: Lakeside Baptist Church - MOPS 9150 Garland Rd. Dallas, TX 75218 For MOPS Use Only: □ Paid In Full Ck # □ Paid $ Ck # Amount Due $
For general information about LBC MOPS 214-324-1425 www.lbcdallas.com/mops [email protected]
Zip: Cell Phone:
Text: Y/N
Email: Birth Date:
Age:
Spouse
NEW for 2015! Please check the group you would like to join: _____MOPS (moms of children birth-kindergarten) _____MOMS Next (must have at least one school-aged child)
Prior MOPS Member? Yes/No
How did you hear about MOPS?
Do you attend church? Yes/ No If so, where? Please list your child/children’s names and birth date of those who will attend MOPPETS: NAME DOB Male/Female Allergies 1. 2. 3.
Registration Fee: $20. Membership Fee: $50 each for fall and spring semesters ($120 total. Payments can be paid in full or at the beginning of each semester) Enclosed (check all that apply): $20 registration (required to reserve spot) $50 for fall semester $50 for spring semester □ I’d like to donate a scholarship to help another mom. □ I need more information on receiving a scholarship. Note: Number of available scholarships is limited. Scholarships cover our MOPS group expenses.
Payment: Make checks payable to LBC/MOPS Mail your check, MOPS registration form & MOPPETS registration form(s) to: Lakeside Baptist Church - MOPS 9150 Garland Rd. Dallas, TX 75218 For MOPS Use Only: □ Paid In Full Ck # □ Paid $ Ck # Amount Due $
For general information about LBC MOPS 214-324-1425 www.lbcdallas.com/mops [email protected]
