SECOND TIME AROUND FORM

www.pacemoms.org

SECOND TIME AROUND FORM

WORKSHOPS FOR NEW & SECOND TIME MOTHERS

WORKSHOPS FOR SECOND TIME MOTHERS:

WINTER 2010 GROUP IS PLANNED!

Mothers attend with the group with their infants (aged from new born to five months) ONLY.

PLEASE UNDERSTAND WE ARE NOT EQUIPt TO PROVIDE DAYCARE FOR YOUR OLDER CHILDREN.

Please Note: Your information will be held confidential and will not be shared with any other entity.

SECOND TIME MOMS: In order to serve you better, please complete and submit the on line form. We will contact you regarding the registration process.

First name:

Last name:

Street, City & Zip:
(Please include your complete address)

Email address:

Home #:

Cell#:

Request information on Second Time Around Mom Groups:

Older child's name & age

Baby's name & DOB or due date

Work plans: If you planning to return to work outside the home, please include the anticipate date.

Best way to contact you:

How did you hear about PACE? Did you do PACE with your older child?

FIRST TIME & SECOND TIME AROUND MOTHERS: In order to serve you better, please complete and submit the on line form. We will contact you regarding the registration process. Please be advised that we have a no refund policy once the classes begin. If you have an event beyond your control that necessitates your withdrawal from the group, please contact us to discuss your situation. A fee of $25 administrative fee will be deducted.

Our Locations:

We provide educational support groups around Montgomery County, Washington,DC and Northern Virginia

For more general information: pace.registrar@gmail.com