King’s Harbor Church MOPS Registration Form

Welcome to King’s Harbor Church MOPS! Please complete this form and forward it along with your $50
registration fee to King’s Harbor Church, Attn: MOPS, 1617 S PCH, Ste D, Redondo Beach, CA 90277. Please
make checks payable to King’s Harbor Church with “MOPS” in the memo section.

Please check here if you are a Mentor Mom (Mentor Mom suggested donation is $28.95)

First and Last Name: _________________________________________________________________

Home Phone: ________________________________ Cell Phone: __________________________

Street Address: _____________________________________________________________________

City: ___________________________________________________ Zip: ______________________

Birthday: _______________________ Email: ____________________________________________

Have you attended MOPS before? ____yes ____no If so, where? ____________________________

What is your Home Church (if any)? ____________________________________________________

If there is a friend you want to sit with, please list her name: ________________________________

Please list your child(ren)’s names and birth dates:

Name: _____________________________________ Date of birth: ___________________________

Name: _____________________________________ Date of birth: __________________________

Name: _____________________________________ Date of birth: __________________________

Name: _____________________________________ Date of birth: __________________________

Which children will attend the MOPS/Children’s Ministry (CM) program?***

__________________________________________________________________________________

Does your child(ren) have any special health concerns or allergies?

___________________________________________________________________________________

Are you expecting a baby? ____ yes ____ no Due date? ___________________________________

Husband’s Name (if applicable): _______________________________________________________

***In August, 2009: Please go to www.kingsharbor.org “children’s registration” to register your child(ren) in
the MOPS/King’s Harbor Church Children’s Ministry (CM) program . Children are placed in CM on a first-
come, first-serve basis. If your child is placed on the waiting list, you are still welcome to join MOPS if you
find another child care option.

“I understand that as a member of KHC MOPS, I will serve one time per semester in the CM program.”
Signed: ___________________________________________________________________________