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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