Pregnancy Support Group Registration
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Email *
Name (first and last): *
City & State *
Phone Number *
What is your approximate due date?
MM
/
DD
/
YYYY
What do you hope to gain from joining group?
The purpose of this social support group is to offer  peer support, education, and resources to expecting parents.  I understand this free community group does not provide counseling, but is an educational and support program designed to provide validation, share coping skills, and promote overall wellness.  I understand that participation in the group is completely voluntary and confidentiality is addressed and respected.  I understand the exception to this is the group facilitator’s legal and ethical responsibility to take appropriate action in the case of an individual intending to do harm to self or others, if abuse or neglect is suspected, or if illegal activity is reported. *
Required
I would like to receive a monthly email regarding future events, skills and worksheets, or other news. *
Required
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