@
Trinity
Registration
Form
Welcome to MOPS! Please complete this form so that we can
learn some basic information about you.
Last name: __________________________First name:
_____________________________M.I.:_____
Phone:
Home:_____________________________________Work:
______________________________
Address:______________________________________________________________________________
City:
______________________________________State:_______________________Zip:____________
Birthday: _____________________________
E-mail: ___________________________________________________
Have you attended a MOPS group before? ❏Yes
❏No
If so, where? _____________________________________
Are you registered for MOPS International
Membership? ❏Yes
❏No
Do you attend a church? ❏Yes
❏No
If so, where?
__________________________________________________
How did you hear about this MOPS group?
________________________________________________________
________________________________________________________________________________________
Please list your child(ren)’s name(s) and birth
date(s):
Name: _____________________________________________Date of
birth: ___________________
Name: _____________________________________________Date of
birth: ___________________
Name: _____________________________________________Date of
birth: ___________________
Name: _____________________________________________Date of
birth: ___________________
Husband’s name (if
applicable):________________________________________________________
For MOPS Group Use Only:
Date registration received:
__________________________________________________________
Discussion Group
assigned:__________________________________________________________
Date registered for the MOPS to Mom
Connection:_________________________________________