Mom Power Registration (Now Full)
Mom Power is a parenting empowerment program for moms and their children ages 0-6. It meets once a week for 10 weeks. You'll have the opportunity to meet other moms and learn important parenting and self-care skills. Snacks and childcare are also provided.

Please complete this form if you are interested in participating in Mom Power. Mom Power is intended for people who identify as female, are age 18 or older, are pregnant or have children age 6 and under. Immigrants, refugees and all who live in Washtenaw County are welcome to attend.

Attendance at group is important. Please only apply if you're committed to regular attendance.

Mother's Full Name *
Your answer
Mother's Date of Birth *
Mother's Ethnicity/Race (check all that apply) *
Street Address
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Do you live in Washtenaw County? *
Phone number
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Email address
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The best way to contact you: *
If it's easier to reach you by social media or by contacting an alternate number, please list that information below.
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