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A SEVENTH-DAY ADVENTIST CONGREGATION
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NEW MOTHERS SELF-CARE REGISTRATION
First name
*
Last name
*
Address
*
Email
*
Phone
*
Emergency Contact
*
Emergency Phone
*
Self-Care Preferences - Do You Have any Dietary Restrictions or Allergies?
*
Yes
No
Which Stations are you Most Interested In (check all that applies)
*
Relaxation and Meditation Station
Massage and Spa Station
Skincare and Beauty Station
Health and Wellness Station
Fitness and Stretching Station
Mental Health and Counseling Station
Crafts and Hobbies Station
Reading and Journaling Station
Nutrition and Cooking Station
Baby Care Station
Would You be Interested in ANY of the Following Activities (check all that applies)
*
Group Meditation
Gentle stretching session
Counseling
Cooking Demonstrations
Other
How Did You Hear About Us
*
Friend/Family
Social Media
Flyer/Poster
Website
Other
Do you have any additional comments or special requests?
Consent and Waiver: I hereby consent to the following (please check all boxes to indicate your consent)
*
I consent to the use of photographs and videos taken during the event for promotional purposes.
I acknowledge that I am participating in this event at my own risk and release the organizers from any liability.
Signature
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