MamaMoon Lite Sign Up Form

What you can expect from a MamaMoon Lite:

Access to quality postpartum resources and breastfeeding support
Connection with our professionally trained volunteers who will support and love you throughout your journey
A special care package delivered to your door

Please feel free to join our FaceBook support group specifically for our Long Island MamaMoon recipients. We know we might be strangers so in this group, you’ll find profiles posted of our volunteer team. Please also check out our password protected support page on our website, where we have tons of resources posted and you can meet our volunteer team! The password is: iambeautiful

First Name *

Last Name *

What is your cell phone number? *

Our volunteers will connect with you via text messaging. Is it ok to text this number? *

Yes No

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is your estimated due date or date baby was born/adopted? *

Day Month Year

Are you planning on or are you breastfeeding? *

Yes No

What is your biggest concern about your postpartum period? *

Emergency Contact Name *

Emergency Contact Number *

Relation *

What is your favorite drink (tea, coffee, etc) and how do you take it? *

What's your favorite snack? *

Do you have any food allergies? *

What did we miss? Please tell us what us we should know:

How did you find out about MamaMoon? *

Disclaimer: I understand that Birth and Beyond Resources, Inc. has taken multiple steps to choose the best volunteers for this program, and all MamaMoon volunteers have been interviewed and reference checked. However, I agree that Birth and Beyond Resources, Inc. is not responsible for the volunteers who have connected with me. I understand that all of the information given here, anything shared with my volunteers, and in the MamaMoon Support Group will be kept confidential and will not be discussed outside of the MamaMoon team, unless our volunteers feel I am suffering from a perinatal mood or anxiety disorder. I agree that if this is the case, it is best for a MamaMoon Leader to call my emergency contact so that they can ensure that I can get the help that I need. *

I agree