Registration for Unraveling Motherhood
A Support Group for Postpartum Moms and Babies ages 0-12 months
Facilitated by Casey Cook, LMSW and Julia Kubek, PhD PMH-C
Please Pick a 6 Week Summer Session
Please Select
6/14 - 7/19: River Birch Room at Mallets Creek Library, Ann Arbor 10:00am - 11:30am.
7/9 - 8/20: 242 Community Center, Ann Arbor 10:00am - 11:30am
Customer Details:
Mother's Name
*
First Name
Last Name
Baby's Name
*
First Name
Last Name
Baby's Age (Must be between 0-12m)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Have you participated in a mom support group before?
Please Select
Yes!
No, This is my first time!
Are you interested in being included in a shared contact list for connecting with other moms in the group?
Please Select
Yes please!
No thanks!
Topics you are hoping are discussed:
Additional Information you would like us to know:
Submit
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