Online New Moms' Talk Group Registration Form

Please fill out this mini-questionnaire so I can get to know you and your baby before we begin.

Due to the coronavirus outbreak, groups will meet online until further notice.

New moms with babies 0-12 months from anywhere in the world are welcome to join.

If you are NEW to our program, you will want to register for the "New Moms Talk Group"

- Spring 2 New Moms Talk Group: 6 Thursdays 5/6 to 6/10, $196, plus Topic Clinics Wednesdays at 11am - FULL

-Summer New Moms Talk Group: 6 Wednesdays, 10am-12pm ET 6/30 to 8/4

- Spring 1 "Deeper Dive 1": 4 Thursdays 5/6 to 5/27, plus Topic Clinics May Wednesdays at 11am

- May Deeper Dive Cohort - Pilot Program: 4 Tuesdays in May 11:00am; Topic Clinics Wednesdays in May 11:00am

Your registration is complete once you send in payment via one of these methods:
• Chase QuickPay or Zelle (
• Venmo (MaryEsther-Malloy)
• PayPal or PayPal Invoice (+ $3 service fee;
• Check - if using this method, please email for address.


Mary Esther Malloy, MA

Mindful Birth NY
Which sessions would you like to attend? (all times Eastern Time) *
Mom's Info
Mom's Name *
Email Address *
Phone Number *
Your Neighborhood (NYC) or City/State/Country (if outside of NYC area)
Where do you hear about the moms' group? (If Garrison Institute, please mention it here.) *
Baby's Info
Baby's Name *
Baby's Date of Birth *
A few get-to-know you questions
Your responses can be super brief or pages long - however you would like to respond!
Why are you looking to join this talk group?
How was your baby's birth?
How was/is the early post-partum for you? (Challenges/things that have gone well)
How is parenting going for you today?
Any particular issues or topics you'd be interested to discuss?
Missed session and refund policy *
Payment for the series is due before the first session, unless you make other arrangements with me. I can provide a full refund up to two weeks before the start date if I am able to fill your space; within the two week mark, I can provide a 50% refund if I am able to fill your space; otherwise, the fee is forfeited or credited to a future group. If I am called to a birth and have to reschedule a session, I will usually hold the make up the week following our regularly scheduled time, same day, time, location, etc. If you are unable to attend this make up, I will refund you the cost of this session.
Payment Information: - Please pay full amount before our start. If you previously paid the deposit of $100 through my website, then simply remit the remaining amount. Thank you! *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy