Pregnant and Parenting Group Form

Pregnancy and Parenting Group

Center for the Developing Child and Family, Ackerman Institute for the Family
This online, no-fee group, is for any adult in their journey towards parenthood. This can be a time that brings up many contrasting emotions and many changes at very different levels. This space will be an opportunity to reflect and share on the meaning of this life transition, on the joys and challenges, hopes and fears. We will endeavor to create a safe space where all experiences are welcome and where we can listen to one another and deeply honor one another’s experiences.

About the co-facilitators: Wendy, Maura, and Sabina, are mothers and mental health professionals committed to the flourishing of families and communities. They are affiliated with the Center for the Developing Child and Family at the Ackerman Institute for the Family and have worked in various capacities with expecting families and families with young children.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender
Due Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Other Phone Number
Ok to text / email?*

TextEmailWant to discuss
Name/Relation of E-contact*
Emergency Phone Number*
Please enter a valid phone number.
Tell us a little about your family and your pregnancy *
Name of your ob/gyn or clinic

Name of DoctorName of Clinic
Phone Number of ob/gyn or clinic
Please enter a valid phone number.
Email of ob/gyn or clinic
example@example.com
By submitting this form I understand that I am signing up for a voluntary online group, the facilitators and organization are not medical providers and take no responsibility for your health*

I read and understand
What are you looking for from joining this group?*
There is no fee to this group.

We ask that you do not share the zoom link that will be provided with others (you can direct them to fill out this form or contact the facilitator).

When you join the group please be in a place that is private and that gives you and others support for participating in the group.

Please keep your camera turned on while you attend the group.
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Pregnancy and Parenting Group