PIPsqueaks Second TIme around Pilot Program

PIP is piloting Second Time Around groups for mamas having their second babies. Please share your contact information and we will be in touch with more information if a group forms near your neighborhood.

Section 1 - Participant Info

Name

First Name

Last Name

Email Address

Address w/ Zip Code

Second Baby's Due or Birth Date

MM

DD

YYYY

Birth Date of Your First Child

MM

DD

YYYY

Will you need childcare for your older child during a daytime group meeting?

Where did you hear about PIP?

Section 2 - Participation agreements

Tdap Policy

I agree to comply with PIP's Tdap Policy**.

Release of Liability

I have read and agree to the terms and conditions set forth in the Release of Liability.**

Signature

Please type your full name below. By doing so you agree to the above.

Is there anything else you'd like us to know?

** Read the Tdap Policy HERE.

** Download/Read the Liability Waiver HERE.

PIPsqueaks Second TIme around Pilot Program

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