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Listening Mothers Registration

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Contact Information
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First Name
Last Name

First Name
Last Name
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To be used for pre-group contact call
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Child's Information
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Please feel free to tell us any additional information you would like to share about your baby

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Please upload a selfie picture of you and your baby to capture this moment in time :) We will take another selfie towards the end of our group time together as well
Class Registration

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Legal Disclaimer:
Withdrawal from a Group: Due to limited class space and payment holding your spot, we cannot issue a refund if you decide to withdraw from a group after the point in time that is 7 days prior to the group starting.

Employee Assistance Program Benefits: Your company or your spouse’s company may provide payment to Listening Mothers through an EAP. If your company wants to talk with Listening Mothers about creating an Employee Benefit, please have them contact us. Withdrawal rules apply as above.

Consent: Participation in this group is voluntary and not a substitute for mental health treatment. In the case of an emergency, contact 911. Virtual  groups may utilize non-HIPAA compliant platform(s) which include potential risks, included interruptions, unauthorized access, and technical difficulties.

Confidentiality: No information about you is released from Nurtureways to anyone without your written permission, except as required by law or court order. We are required by law to report suspected child abuse (regardless of when it occurred), elder abuse and clear, concrete evidence of planned acts of violence.

 

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