1

Your Info 👩* This field is required.

First Name

Last Name

Email

Phone

Your Birthday! ✨

Marital Status

2

Husband’s Name* This field is required.

3

Current Address 📌* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

4

Will you require childcare?* This field is required.Childcare is $25 per child per semester. We don't charge for children beyond your 2nd child

YESNO

5

Please list your children (1 to 5 yrs. old) who will be needing childcare: 👩‍👦* This field is required.You must click "SAVE" to save the information for each child.

6

Your children (1 to 5 yrs.) requiring childcare:

{pleaseList43}

If incorrect, please click PREVIOUS below and correct your information.

NOTE: You must click "SAVE" on the previous page to save each record of your children.

7

Discount CodeIf you have a discount or other code, enter it here.

8

ChildrenCharge* This field is required.

9

Have you attended a MOPS group before? 🤗* This field is required.

YESNO

10

Where did you attend MOPS? * This field is required.

11

Adjustment

12

Multiplier

13

RATETHIS IS THE RATE BASED UPON THE NUMBER OF CHILDREN REQUIRING CHILDCARE

14

This is your MOPS Registration Fee* This field is required.This is the TOTAL based upon your number of children requiring childcare.

Gilroy MOPS Fee

USD

+ OR enter a custom value

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

16

Interested in being a MOPS Mentor Mom? 💕* This field is required.If so, information will be emailed to you.

YESNO

17

Home Church ⛪* This field is required.

South Valley Community Church

I do not have a home church

18

Interested in being part of the MOPS volunteer team? 💙* This field is required.If so, information will be emailed to you.

YESNO

19

Please verify that you are human* This field is required.

Your children (1 to 5 yrs.) requiring childcare: {pleaseList43}

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.

Your children (1 to 5 yrs.) requiring childcare:

{pleaseList43}