Online Forms

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5. Mother's First Group Registration Form - March 23, 2020 Session
   First-time moms have extra challenges of isolation and limited supports during the pandemic. This group offers a safe space where first-time moms with children under one can come together to talk about being a new parent during COVID-19. This group will give new moms the opportunity to build community connections with other new moms and to learn about different techniques, tools, and resources. Please complete the following form to register for the March 23 Session.
7. Session Details
   Date: March 23, 2020
   Time: 10:00 - 11:00 a.m.
   Location: Zoom (invite sent via email upon registration)
9. PLEASE NOTE: if you are NOT a first-time mom with a baby under one year of age, this group will not be as beneficial for you. Please fill out your contact information below and you will be contacted to find resources that are the right fit for your family.
11. Mother's First Name*
12. Mother's Last Name*
14. Baby's First Name*
15. Baby's Age*
17. Email Address*
18. Phone Number*
20. 1. Please list two topics that you would like to learn about related to being a new mom:
22. 2. Do you need support accessing Zoom?

    1. Yes
    2. No
24. 3. Part of this group involves sign-alongs to interact with your little one. Do you have a way to print or view these song sheets during the group?

    1. Yes
    2. No
26. 4. Would you like to learn more about additional parent education and support services? *

    1. Yes
    2. No

    Your contact information will be used by the Caregiver Education Coordinator to contact you or share information with you
28. 5. Where do you live?*

    1. Hinton
    2. Edson
    3. Yellowhead County
    4. Other
30. 6. Additional Comments
    (please add any additional feedback here)
32. To participate in this online session, you must agree to protect privacy and confidentiality for yourself and other participants. *

    1. I AGREE I will not share my invitation or password with others
    2. I AGREE I will strive to view this session in a private area
    3. I AGREE I will not record, take screenshots of, or share this session
34. Thank You!
    Thank you for registering for the March 23 Mother's First Group! Zoom invites will be sent to the email you provided.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field