Moms' Meetup Registration: Fall, 2023

Thank you for registering for Moms' Meetup! Please fill out this form and click Submit.

Name:

Email:

This address will receive a confirmation email

Phone Number:

Secondary Phone:

Address:

Church affiliation:

Please select all that apply.

Member at EBC Attend at EBC Attend another church Currently do not attend a church

I would like to attend the:

Please select one option.

Thursday evening group (no childcare) Friday morning group (childcare provided)

Childcare Registration:

Please list ALL of your children below, even if you are attending an evening moms' meetup, or your children will not be attending the daytime moms' meetup with you. Don't forget to enter each child's age and birth date. This helps us greatly when planning childcare and allows us to get to know your family better. Thank you!

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

If you have additional children, please list their information here:

Do any of your children have any type of allergies or medical needs? (inhaler, food allergy, etc.) If so, please list specifics below.

Please indicate if you authorize us to share the information on this form with the other members in your Moms' Meetup group.

Please select all that apply.

Yes No

The cost of the Mom Strong book we are using this fall is $9. Please choose an option below.

I would like to pay for my book now. ($9) I would like to pay for my book at our first meeting. ($0 now)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Thank you for registering for Moms' Meetup! Please fill out this form and click Submit.

Moms' Meetup Registration: Fall, 2023

Description

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