Next Step (for Moms)


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Next Step

(for Moms)

…nurturing our faith and parenting sister to sister

A ministry for moms of school aged kids through Highland Community Church at the Wausau Campus for the 2017/2018 school year

Registration Form 2017-2018 Please complete this form so we can learn some basic information about you. First Name: _______________________ _____________ Last Name: ____________________________________________ Address: _____________________________________________________________________________________________ City: ___________________________________ State: __________________ Zip: _________________ Preferred Phone: (

) _________-________________

Preferred method of contact: e-mail/phone/Facebook (circle one)

Email: _____________________________________ Birthday _____/_____/_____ Anniversary ______/______/_______ Do you attend a church □ Yes □ No If so, where: ___________________________________________________________ Husband’s name (if applicable): ___________________________________________________________________________ Please list your child(ren) name(s) and birthdate(s) and school attending (if applicable)

Name: _____________________________________ DOB: ______/______/_______ School:_________________

Will they need childcare? □ Yes □ No

Name: _____________________________________ DOB: ______/______/_______ School:_________________ □ Yes □ No Name: _____________________________________ DOB: ______/______/_______ School:_________________

□ Yes □ No

Name: _____________________________________ DOB: ______/______/_______ School:_________________

□ Yes □ No

Name: _____________________________________ DOB: ______/______/_______ School:_________________ □ Yes □ No Name: _____________________________________ DOB: ______/______/_______ School:_________________

Payment for childcare only - $15/year. Make checks payable to Highland Community Church.

□ Yes □ No