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Pregnancy Support Group Registration
This is to be completed by the parent attending the pregnancy support group. This form only needs to be completed once. Please complete one for each parent/partner attending
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* Indicates required question
Email
*
Your email
Your name
*
Your answer
Baby's due date
*
MM
/
DD
/
YYYY
Expected place of delivery - please put the hospital/birth centre/location name
*
Your answer
Your postcode
*
Your answer
Your contact telephone number
*
Your answer
I am the.....
*
pregnant mother/parent
father/partner of the pregnant mother/person
Other birth partner
friend or relative supporting parent to attend the group
Next of Kin Name and Contact number
*
Your answer
What are you hoping to get from the group? Please tell us if you have any worries or concerns.
*
Your answer
Where did you hear about the group?
*
Facebook
Instagram
Website
Word of mouth
Relative
Health professional
Other
Required
I understand that this is an open group and I am responsible for any information I share about myself and my/our pregnancy?
*
I understand
Required
Positive Birthing and Beyond will sometimes take pictures of our events and sessions for promotion of services and for feedback to our funders. I consent to being in the pictures, but i understand that i can opt out at the time if i choose.
*
Yes
Did you know we have a facebook group - please like and follow us there for updates.
*
Yes I understand
Required
A copy of your responses will be emailed to the address you provided.
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