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  • Prenatal Yoga Registration

    Welcome! We're so glad you're here. This form is required in order for you to use Berkshire Nursing Families services like the Prenatal Yoga series. Some of the information you share—like demographics—may be used for grant reporting to help us continue offering free services to families across Berkshire County. All responses are kept confidential in our HIPAA-compliant system and only accessed by relevant BNF staff. We do not share identifiable information outside of our organization without your explicit permission. After completing this intake form, you’ll be asked to review and sign our Consent to Services and Release of Information forms. Thank you for taking the time to complete this—we're honored you're a part of our community. If for whatever reason completing this form presents a barrier to care for you, please reach out to us at intake@berkshirenursingfamilies.org
  • About You


  • Household Information

  • BNF Client Consent Form

    Acknowledgement of your rights and consent to services is required to receive care from BNF.
  • Our Services

    Berkshire Nursing Families, Inc. (BNF) is a non-profit organization offering free, inclusive services to all families, funded through community donations and grants. Our clinical staff are trained in perinatal mental health and nutrition, and are Certified Lactation Counselors (CLCs) or International Board-Certified Lactation Consultants (IBCLCs). These credentials ensure that we provide current, evidence-based care in breastfeeding/chestfeeding, infant feeding, and parental wellness.

    You are invited to participate in our peer support and parenting playgroups. These groups offer a welcoming space for connection, encouragement, and shared learning among families. They may be facilitated by BNF clinical staff, trained peers, or both. Participation is completely voluntary.

    If at any time you wish to withdraw your consent for any portion of our services—including group participation or data use—please speak directly with your BNF provider or contact us at info@berkshirenursingfamilies.org or (413) 344-2800. Withdrawing consent will not impact your access to care or other services.

    Your Private Health Information
    BNF collects limited information such as your name, contact details, and demographic information to provide appropriate care and track service reach. All records are stored securely in HIPAA-compliant, encrypted systems accessible only to authorized BNF staff. 

    Yoga Participation
    By participating in class you acknowledge that it involves physical movement and exercise, which may carry some risk of injury. You understand that you are responsible for listening to your body, modifying as needed, and consulting a healthcare provider if you have any concerns. 

    Our yoga instructor is certified, experienced, and the practice is trauma-infomed. While yoga and exercise can be therapeutic, information shared does not replace the care of a trained healthcare professional.

    You voluntarily assume all risks related to my participation and release Berkshire Nursing Families and it's instructor from any liability. In signing the waiver below you confirm that you are in suitable health to participate and agree to practice at your own discretion.

    Group Participation & Confidentiality
    We ask that all group participants respect one another’s privacy. Please do not share personal details or stories shared by other group members outside the group setting. Our facilitators will also maintain strict confidentiality of what is shared during groups, unless there is a legal obligation to report.

    Photography and Images
    Occasionally, we may request permission to take photographs during a group session for use in internal reporting, staff training, or promotional materials (e.g., website or newsletters). You will always be asked before any photographs are taken, and you may decline without any impact on your services. No photos will be taken without explicit, written consent.

    Communication
    BNF communicates via HIPAA-compliant, encrypted platforms including secure email, texting, and telehealth systems. Images and personal details will never be shared without your consent.

    Legal & Ethical Disclosures
    Your privacy is very important to us. We will never share your personal information with anyone outside of BNF without your written permission.

    There are a few rare situations where we are legally required to share information, such as:

    • If we have a concern about possible abuse or neglect of a child or vulnerable adult
    • If there is concern that you or someone else may be at immediate risk of harm
    • If a court or legal process requires us to share certain information

      Whenever possible, we will talk with you first if these situations arise.

    Questions or Concerns?
    If you have questions about this consent form, are uncomfortable signing, or would like to decline any part of the service, please reach out to us. Our services will remain available to you. You can contact us at info@berkshirenursingfamilies.org or (413) 344-2800 to speak directly with a staff member.

    By signing below, you confirm that you:

    Understand your rights to decline or withdraw from services at any time without penalty
    Acknowledge the general risks associated with physical exercise

    Acknowledge the group confidentiality expectations
    Know how to contact BNF with questions or concerns
    Consent to participate in BNF's support or parenting groups under the terms above

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