Rancho Bernardo Community Presbyterian Church MOPS Registration Form 2012-2013 Please tell us about you and your children. Name:______________________________________________________ Home #:__________________________ Cell #:_________________________ Address:____________________________________________________ City:_______________________________ Zip:_________________________ Email:______________________________________________________________________________________ Birthday:________________________ Marital Status:_______________________ Anniversary:______________________ Spouse’s Name:__________________________________________ Do you attend church?__________ If so, where?____________________________________________________________________________________ ♥ Children’s information: Childcare (aka: MOPPETS) is required for all children 6 months and older as of September 1 st, 2012. Name:______________________________ DOB m/d/y:____________________ MOPPETS needed: Y ______
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Name:______________________________ DOB m/d/y:____________________ MOPPETS needed: Y ______
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Name:______________________________ DOB m/d/y:____________________ MOPPETS needed: Y ______
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Name:______________________________ DOB m/d/y:____________________ MOPPETS needed: Y ______
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Childcare is required starting in January for all children 6 months and older as of January 1st, 2013. Will you have an additional MOPPET?____________ ♥ Table Preference: We will try our best to seat you with at least one other person you request, but this is not a guarantee. Please list those you would like to sit with here: ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ♥ Would you like to serve on any of the following teams? Check all that apply: Craft:____ Finance:____ Hospitality:____ Publicity:____ Registrar:____ Service:____ Speaker Coordinator:____ Special Events: ____ Table Leader:____ Table Leader Coordinator:____ ♥ Are you in need of a partial scholarship? Y_________ N_________ (If yes, please turn in your completed form only and someone will contact you.) ♥ Are you in need of a payment plan? Y _________N _________ (If yes, please pay the $50 deposit now and we will collect 1/4th of the balance in August, 1/4th in September & 1/4th in October) ♥ Are you a Mentor Mom? Y___________ N__________ ♥ Registration Fees & Mailing Your Form Fees for the YEAR are $150 for mom plus $40 for each child. For example: Who is registered? Mom Mom + 1 child Mom + 2 children Mom + 3 or more children Please make your check payable to RBCPC and send to:
Registration Fee for Sept. ’12-May ’13 $150 $190 $230 $270 (Family maximum registration fee.) Cindy Kelford, MOPS Finance 11465 Escoba Place San Diego, CA 92127
LOVE MOPS…WANT TO GIVE MORE? Include gift with check and indicate amount here: $_____________ Note for returning moms only: Your spot is secure if you turn in your registration and deposit by May 16th, 2012. Open registration begins May 17th, 2012. Childcare spaces are limited. Thank you for registering for RBCPC MOPS! Our email is:
[email protected] or to learn more about MOPS International, visit www.mops.org. For Registrar use only: Date Received: _______________ Deposit of $50 Received:_______________ Balance Received:__________________ Entered into Registrar Database:
Entered into MOPS International Database:
Snack Donation provided:
