Mentor Moms Registration

CCC Mentor Moms Registration Fall 2018
This information is to register you for Mentor Moms, which will meet on Thursdays from 9:30AM to 11:30AM at Christ Community Church in Simpsonville. Activity Fee is $20 per semester and should be paid by our first meeting: September 6th. For childcare, please refer to the other form in the registration email.
Name

First Name Last Name
Email
example@example.com

Address

Phone Number

Area Code Phone Number
Church
Do you have any children who want to be a part of the Home School Table? If so, how many?
Please group me with... (Preference will be considered but is not promised.)
Name of Child (Please fill out this information for all the children in your family. This information is for your Mentor Mom; not for childcare purposes.)
Gender
Age
Name of Child
Gender
Age
Name of Child
Gender
Age
Name of Child
Gender
Age
Name of Child
Gender
Age
Name of Child
Gender
Age
Should be Empty:

CCC Mentor Moms Registration Fall 2018