CMC Membership Registration Form

St. Kilian Catholic Mothers Collective Registration
Catholic Mothers Collective is a parish ministry for mothers of babies and school-aged children. This information is used to communicate with members and create our membership roster.
Name

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number:

Area CodePhone Number
Food allergies or restrictions:
Emergency Contact Name and phone number:
Which Special Interest Groups (SIGs) would you like to be added to?
Childcare Information

Please only fill out the following if you are requesting childcare. Please fill out one block per child that will be in childcare. Financial assistance may be available, contact leadership to inquire. Those who will not be using childcare please proceed to the bottom of the page to continue.
Child 1
Name
Birthdate

MonthDayYear
Date
Potty Trained? Allergies or medical conditions? Special Instructions or Comments
Child 2
Name
Birthdate

MonthDayYear
Date
Potty Trained? Allergies or medical conditions? Special Instructions or Comments
Child 3
Name
Birthdate

MonthDayYear
Date
Potty Trained? Allergies or medical conditions? Special Instructions or Comments
Child 4
Name
Birthdate

MonthDayYear
Date
Potty Trained? Allergies or medical conditions? Special Instructions or Comments
Child 5
Name
Birthdate

MonthDayYear
Date
Potty Trained? Allergies or medical conditions? Special Instructions or Comments
Once you click submit you will be shown two links.

One to pay for the Semester ($40).

One to pay for childcare ($80 for all 8 Fall meetings).

Once we recieve your payment, we will contact you about your Membership. Thank you!
Should be Empty: