2020-2021 MOPS @ Saint Paul's Registration
**Childcare is FULL. Moms not needing childcare can register and pay  as usual. Those needing childcare, please submit form without payment to be added to our waiting list**

Please complete all fields and make a check payable to Saint Paul's MOPS and return to the membership chair, Lindsay Eisel, or finance chair, Emily Andrews.  Dues for 2020-2021 are $115.00.  You may also send via Venmo (saintpaulsmops).
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First Name *
Last Name *
Email *
Address *
City *
State *
Zip Code *
Preferred Phone *
What is the best way to contact you? *
Required
If Other, please describe:
Birthdate *
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DD
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Your Facebook login (if not your name)
How did you hear about us?  (If from a friend, then who was the friend?) *
Child 1 Name *
Child 1 DOB *
MM
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DD
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YYYY
Does Child 1 need MOPS Kids (childcare)? *
Child 2 Name
Child 2 DOB
MM
/
DD
/
YYYY
Does Child 2 need MOPS Kids (childcare)?
Clear selection
Child 3 Name
Child 3 DOB
MM
/
DD
/
YYYY
Does Child 3 need MOPS Kids (childcare)?
Clear selection
Child 4 Name
Child 4 DOB
MM
/
DD
/
YYYY
Does Child 4 need MOPS Kids (childcare)?
Clear selection
Please include ALL allergy information for your child(ren) *
Who has permission to pick up your children in case of emergency (name and phone number)? *
Additional emergency contact (name and number please)
Family Doctor
How would you like to pay the Saint Paul's MOPS group fee of $115? (This consists of MOPS International fee $31.95 and MOPS local dues $83.05)  **Childcare is FULL. Moms not needing childcare can register and pay  as usual. Those needing childcare, please submit form without payment to be added to our waiting list** *
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