Safe Mom Space Registration

Safe Moms Space

A Judgement free zone
Attendee Information

Please fill name and contact information of attendees.
Your Name

PrefixFirst NameLast Name
Contact Number

Area CodePhone Number
Will you bring children with you? If so, how many?
Ages of Child(ren)
I understand that Dare Academy and ID2C Family Life Center is not resposible for any lost or stolen items. Dare Academy & ID2C Family Life Center is not responsible for any preventable injury. All parties are to remain where event will be held (1656 Kaighn Ave 2nd Floor Camden, NJ 08103).

Children will be attended by certified babysitters as well as an adult will be present. In the event snacks are being served, it is the parents resposinilty to notify administraive party of any known allergies.
Should be Empty:

Safe Moms Space