Calvary Baptist Church

Just Among Moms (JAM) 2019-2020 Registration Form 2

Just Among Moms (JAM) Registration

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Name: *


First Name	Last Name

Address: *


Address

Address Line 2

City	State	Zip Code

Email: *

Email Address

Phone: *

Phone Number

Birthday *

If you are married, what is your husband's name?

Have you been a member of JAM (formerly MOPS) before? *

Select one

Yes
No

If no, how did you find out about us?

The JAM registration fee is $20.00 this year. All money will go towards funding our program, including crafts, speaker fees, year-end gifts, etc...

We do not want anyone to not be able to attend because of the cost. We will be offering reduced memberships or full scholarships to those who are in need.

Will you be able to pay the JAM membership fee? *

Select one

Yes
No

If no, please indicate which you are seeking:

Select one

Full Scholarship
Reduced Membership

Please list the names and birthdays for ALL of your children. Please indicate if you will be bringing your children to JAM.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

Name:


First Name	Last Name

Birthday:

Will you be bringing this child to JAM with you?

Select one

Yes
No

If yes, please indicate any allergies.

* required