Postpartum Group Registration

The Village Series: Group Registration Form

Thank you for your interest in AWOHC's latest group for new parents! Please fill the form below - email any questions to kara@aworkofheartcounseling.com
Participant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Cell Phone
Please enter a valid phone number.
Please share any specific information you would like the facilitator to know (i.e. specific questions you would like answered anonymously during group, challenges you are having in postpartum, etc)*

Emergency Contact Information
Name*

First NameLast Name
Relationship to Participant*
Mobile Phone*
E-mail*
example@example.com

Signature & Payment
By signing and submitting this registration form, you understand and agree to all policies.

Policies:

This is an open, drop in group. All participants must register/pay for each session they would like to attend. No refunds will be provided unless requested at least 24 hours or more ahead of the group.

This is a processing and psychoeducational/support group, NOT psychotherapy. All participants MUST complete an informed consent for the group prior to participating below, acknowledging understanding this.

Once you click "Register" you will be redirected to pay the registration fee. You may use your credit/debit card or Apple/Google Pay.
Signature of Participant*

Clear
Today's Date*

MonthDayYear
Date

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The Village Series: Group Registration Form