MOPS at OCC Online Registration

To Register for MOPS at OCC
Please fill out the MOM Registration form below

After registering online, you will still need to mail in your yearly, non-refundable registration fee of $23.95.

Please make checks payable to Overlake Christian Church (OCC)

You may also use your banks billpay online or drop off at the church office during business hours

Overlake Christian Church
Attention: MOPS
9900 Willows Rd NE
Redmond, WA 98052

425.702.0303

Mom's First Name Last Name , MI

Daytime Phone () - ext. Alt/Cell () - ext.

Address City State Zip Code

E-mail

Birthday / / (MM/DD/YY)

Have you attended a MOPS group before? Yes No - If so, where?

Are you registered for MOPS-to-MOM Connection through MOPS Int. Yes No Not sure?

Do you attend church? Yes No - If so, where?

How did you hear about us? Friend Flyer (from where)
Website Church bulletin Other (please specify)

Husband's name (if applicable): First Name Last Name

You may request a discussion group leader or a friend to be placed with (please limit your request to one friend.) We will do our best to place you in that group; however, we cannot guarantee placements.

MOPPETS Registration for your Child(ren)
Please note, due to the large class sizes of our children's program and the need for space for new children, if your child misses three or more MOPS classes in a row, he/she may be placed on a waiting list until adequate staffing can be found. Thank you for your understanding.

By registering your children for MOPPETS, you grant MOPS at OCC and Overlake Christian Church the authority to act in the stead of a parent should a medical emergency arise.

Please list all your child(ren)'s names and birth dates (including those not attending with you marked *).

Emergency Contact:
First Name Last Name Phone Number ext.

Child #1 Attending MOPPETS
First Name Last Name Birthday // Age

Favorite toys, songs, games, foods, comforts:

Any other comments - special needs - allergies

Child #2 Attending MOPPETS
First Name Last Name Birthday // Age

Favorite toys, songs, games, foods, comforts:

Any other comments - special needs - allergies

Child #3 Attending MOPPETS
First Name Last Name Birthday // Age

Favorite toys, songs, games, foods, comforts:

Any other comments - special needs - allergies

Child #4 Attending MOPPETS
First Name Last Name Birthday // Age

Favorite toys, songs, games, foods, comforts:

Any other comments - special needs - allergies

Would you like to contribute to our scholarship fund?
Yes. Included in my check is my contribution of $ to help as many moms as possible.

By registering for MOPS at OCC, you are granting us permission to use photographic images containing yourself and or your child(ren)'s photograph/likeness for various purposes such as printed material, publications, displays, video productions, PowerPoint presentations, etc. as well as the various MOPS at OCC and Overlake-related websites on the World Wide Web (www). You also acknowledge MOPS at OCC and Overlake's right to crop or treat the photographic images at its discretion. You also grant us permission to publish your information in a MOPS directory to be passed out to registered MOPS moms only and is NOT to be used for solicitation purposes. Thank You.

I am in need of a scholarship

How a Scholarship will help my family:

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