Village Church MOPS
Better Moms Make A Better World.
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Village Church
3216 W. Victory Blvd.
Burbank, CA 91505
(818) 843-4883
Fill in the form below to send me your MOPPETS registration info. You can pay your fees when you attend your meeting.
Fields marked with an asterisk (*) are required.
Which MOPPETS group will your child be attending?
*
Wednesday MOPPETS
Saturday MOPPETS
Child's Name:
*
Birthdate:
*
Parent's Name:
*
Address:
*
Home Phone:
*
Cell Phone:
Your Email:
*
Any Known Allergies/Special Needs:
*
Yes
No
If yes, Please list:
Child's Name:
Birthdate:
Any Known Allergies/Special Needs:
Yes
No
If yes, please list:
Child's Name:
Birthdate:
Any Known Allergies/Special Needs:
If yes, please list:
Child's Name:
Birthdate:
Any Known Allergies/Special Needs:
If yes, please list:
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