A non-denominational church in Livonia, Michigan with great teaching, worship, and kid's ministries.

MOPPETS Registration

Fill out the information below to register your child for MOPPETS!

General Information

Family Name: *

Address: *

City: *

Zip Code: *

Phone Number: *

Email:

Family Information

Father's Contact Information (Name, Phone, Email, Cell Phone):

Mother's Contact Information (Name, Phone, Email, Cell Phone):

Children's Information (you may register up to five children on this form)

1. Child's Info (Name, Birthdate, Allergies/Meds, Concerns):

2. Child's Info (Name, Birthdate, Allergies/Meds, Concerns):

3. Child's Info (Name, Birthdate, Allergies/Meds, Concerns):

4. Child's Info (Name, Birthdate, Allergies/Meds, Concerns):

5. Child's Info (Name, Birthdate, Allergies/Meds, Concerns):

Is your child still in diapers?:

Yes

No

Is your child walking?:

Yes

No

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Math question: * minus ten equals zero

Solve this math question and enter the solution with digits. E.g. for "two plus four = ?" enter "6".

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