Families of the China Moon Membership Registration

Please fill out the following form and then click the SUBMIT button at the bottom.

If this is a renewal, and your information has not changed in the past year, then only fill in the following four items:

Mark the box "Use Last Year's Information"
Enter "Parent name(s)"
Enter "Child Name"
Enter child's current "Grade in School"
Enter child's current "School Name"

	Use Last Year's Information

Family Information
Parent name(s):
Street:
City, State, Zip:
Home Phone:
Cell Phone:
Email address 1:
Email address 2:
DTC/LID:
(if waiting)

First Child Information
Name:
Birthday:
School Name:
Grade in School:
SWI:
Adoption Day:
Province:

Second Child Information
Name:
Birthday:
School Name:
Grade in School:
SWI:
Adoption Day:
Province:

Third Child Information
Name:
Birthday:
School Name:
Grade in School:
SWI:
Adoption Day:
Province:


Other children: (please note DOB and grade-in-school)