During the COVID-19 health crisis, ABC Support Circle will be online. We ask that you read and copy/complete the following form and email it to firstname.lastname@example.org and email@example.com
THANK YOU and WE LOOK FORWARD TO MEETING YOU
Name/Age of Children: _______________________________________________
Cell Phone: ____________________________________________________________
Emergency Contact: ___________________________________________________
Emergency Contact’s Cell Phone: _______________________________________
Partner/ Spouse: _______________________________________________________
Adjustment to Baby Challenges (ABC) support circle is a perinatal support group for members’ mutual benefit. It is to help women who are experiencing difficulties adjusting to the perinatal experience and/or a perinatal mood disorder. ABC Support is not group therapy or counseling, and it is not a substitute for mental health treatment. If you feel you may require additional support and/or a referral to a medical or mental health provider, please speak with one of the facilitators, who will be glad to help you find resources.
The purpose of the group is to create a non-judgmental environment where women can share thoughts and feelings, talk about challenges, receive support, and obtain information about perinatal disorders. Our mission is to empower women and provide hope during the recovery period. To foster a safe and supportive environment, we ask that all members abide by these guidelines:
*Whatever is shared in the group, stays in the group. Keep it all confidential.
*We have no “mommy camps” (i.e. breastfeeding vs. Bottle-feeding, stay-at-home vs. paid employment, etc.). We respect whatever works for one may not work for another. This circle isn’t a place to give advice. If asked, we may suggest ideas based on what has worked for us in the past, without pushing ideas on others.
*Babies are welcome, (and everything baby-feeding, changing, soothing!) though you are also welcome to come alone.
*To protect the privacy of other group members, we ask that family members and friends not attend.
Support group conversations are confidential. However the group’s leaders will contact my emergency contact, physician &/or therapist if I appear at risk of harming myself or someone else. By including my email address, I agree to receive reminders/notifications about the circle from time to time. I have read the above and agree to abide by them while participating in ABC Support Circle.
___________________________________________ ____________________________ Signature Date