MOPs Registration - 2021-2022

Member Information

Name

This address will receive a confirmation email

Phone

Address

Birthdate

Husband's Name (if applicable)

MOPs Kids Registration

Please enter information for each child who you expect will be accompanying you to MOPS meetings. You do not need to give us information about older children.

We are seeking more volunteers for our MOPS Kids, but our goal is still to provide childcare during our meetings. If you know of anyone who would enjoy loving our littles while we meet, please have them contact Tara Darling at tdarling@immanuelrapids.com or 714-423-3260.

1st Child (full name)

1st Child Birthdate

1st Child - Special Needs (allergies, etc.)

2nd Child (full name)

2nd Child Birthdate

2nd Child - Special Needs

3rd Child (full name)

3rd Child Birthdate

3rd Child - Special Needs

4th Child (full name)

4th Child Birthdate

4th Child - Special Needs

Emergency Contact - Name

Emergency Contact - Phone Number

Emergency Contact - Relationship

Registration Fee

Option 1: Register with Immanuel Lutheran Church to attend our meetings for $45 for the entire year, and we will also register you for MOPS International

Option 2: If you have already renewed your MOPS membership on your own, or if you have registered with another group, please register for our Immanuel meetings for $15 for the entire year.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Thank you for registering for MOPs at Immanuel!

Registration for MOPs at Immanuel is $45 for the 2021-2022 year.

If you have any questions, please email mops@immanuelrapids.com, or contact Tara Darling at (715) 451-3387.

We do not want money to prevent anyone from being a part of our community! To that end, there are scholarships available upon request. If you need a scholarship, please reach out to Tara Darling before submitting your registration form.

MOPs Registration - 2021-2022

Description

Please Fix the Following