MOPPETS Registration

AHUMC MOPS 2018-2019 MOPSkids Registration

Please fill out this form for your child(ren) that will be using our childcare services. The church is able to provide childcare for children ages 3 months to 11 years. (Meetings, PNO, Rummage Sale, etc.)
Mother's Name

First Name Last Name

Address

Phone Number where you can be reached during our meetings (i.e. cell phone)

- Area Code Phone Number
Alternate Phone 1

- Area Code Phone Number
Alternate Phone 2

- Area Code Phone Number
Father's Name (if applicable)

First Name Last Name
MOPPETS Child 1

First Name Last Name
MOPPETS Child 1 Birthdate

- Month - Day Year
MOPPETS Child 2

First Name Last Name
MOPPETS Child 2 Birthdate

- Month - Day Year
MOPPETS Child 3

First Name Last Name
MOPPETS Child 3 Birthdate

- Month - Day Year
Favortie Toys, games, songs, foods
Special needs or instructions, food allergies, medical conditions
Who has permission to pick up your child(ren) in case of an emergency?
Father (if applicable)

First Name Last Name
Father's Phone Number

- Area Code Phone Number
Father's Alt. Phone Number

- Area Code Phone Number
Relative's name

First Name Last Name
Relative's Phone Number

- Area Code Phone Number
Other - Friend or Neighbor's name

First Name Last Name
Other Phone Number

- Area Code Phone Number
Family Doctor's Name or Clinic

First Name Last Name

Doctor or Clinic Address

AHUMC MOPS 2018-2019 MOPSkids Registration