Cherished Mom Perinatal Support Virtual Agreement
This agreement is to maintain the environment and safety of those participating in the Perinatal Support Group in person and virtually. We want it to be a welcoming and a judgement free zone and a safe space to discuss matters relating to the struggles of new motherhood. Once submitted and answers verified, you will be send the link to join the virtual group for the upcoming scheduled Monday. Groups are scheduled every other Monday.
Name (First and Last) *
Your answer
Email *
Your answer
Address *
Your answer
Phone number *
Your answer
Delivery Date or Estimated Due Date *
MM
/
DD
/
YYYY
Emergency Contact Information *
Your answer
I will not share the virtual link, once obtained. *
I will participate in this support group from a private location, to maintain the safety of the entire group. *
I will not discuss what is shared during the group session with anyone (what happens in group, stays in group). *
If I sign off abruptly, without warning, one of the facilitators will call or text me to check on me. *
This is purely a peer to peer support group, led by volunteers. This group is not meant to diagnose or treat, nor does it take the place of therapeutic treatment. If you are in crisis or are feeling unsafe, please call 911 or go to the nearest emergency room. National Suicide Hotline: 1-800-273-8255 *
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