MamaCore 2019
Welcome to MamaCore! YOU are the reason this class was created, and because of that I want to make sure I know a few key things about you before we begin our time together. We are all in different stages of the motherhood transition, this questionnaire was created to give me (Kate) a better understanding of where you are on your journey and what I can do to best support you.
What is your name? *
Your answer
Where are you on the "motherhood spectrum"? This means: # pregnancies, # births, # months or years postpartum from your youngest baby. (Ex: Jane has 3 children, she experienced 1 miscarriage, her children are 8, 5, and 2 years old. Jane's "motherhood spectrum" = 4 pregnancies, 3 births, 2 years postpartum). *Please feel free to share any additional information you feel is important for me to know around this topic. This could include: adoption, fostering, miscarriage, infant loss, anything at all that you feel pertains to your experience on the "motherhood spectrum". **Please also know that you only have to share what you feel comfortable sharing.** *
Your answer
Do you have any injuries, or areas of concern, that I should know about? If so, please tell me as much as you are willing to share.
Your answer
Is there a physical task or exercise that you currently can not do because you feel pain, or you feel you are not strong enough to perform it?
Your answer
What would you like to get/achieve from taking this class?
Your answer
Is there anything else you want me (Kate) to know before we get started?
Your answer
I give Dr. Kate Antoniotti permission to view the information I share here. I understand that this information is pertaining to my chosen participation in MamaCore Semester Class held at Downdog Yoga Center. *
Required
I have been cleared to participate in exercise by my birth provider. *
Required
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