MamaMoon Sign Up Form
  • We will send you a confirmation once your form is sent with details on how to access our Support page, so please check your spam folders! 
  • If you are still pregnant or not ready for your visit, don't forget to follow up after the baby is here and let us know when you're ready for your visit.
  • All of the information shared here is kept confidential within the MamaMoon team.
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About You
First Name *
Last Name *
What is your cell phone number? *
Is it ok for us to text this number? *
Email address *
What is your home address? *
What is your favorite drink (tea, coffee, etc) and how do you take it? *
What's your favorite snack? *
Do you have any food allergies? *
How did you find out about MamaMoon? *
About your Postpartum
What is your estimated due date or date baby was born/adopted? *
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Are you planning on or are you breastfeeding? *
What is your biggest concern about your postpartum period? *
Visit Information
Are you ready to schedule your MamaMoon? *
What type of visit do you prefer? *
  • An in-person visit will be scheduled within 2 weeks of when you are ready. If we are unable to schedule a visit within two weeks, we will contact you to switch your visit to virtual.
  • An in-person visit will consist of two volunteers visiting your home during a time frame when you're available. You'll choose the times that you're available on this form. 
  • A virtual visit will take place using the Zoom platform with two of our volunteers. 
If siblings will be home during the visit, we would like to acknowledge them. Please list their names and ages:
Some of our volunteers are allergic and some are weary of pets. Please list any pets in the household and whether they are large/small. Please also indicate if the pets can be caged during the visit.
Some of our volunteers are sensitive to smoke. Does anyone smoke in your home? *
On a scale of 1 to 10, how comfortable are you with our volunteers holding your baby to allow you a break? *
All of our volunteers have signed agreements to be in good health, wash their hands, and not wear perfume on a visit. We currently also do not have any volunteers who smoke. If you answer less than 9, we won't offer.
Not comfortable at all
Very comfortable
On a scale of 1 to 10, how comfortable are you with our volunteers doing light housework for you while on your MamaMoon? *
If you answer less than 9, we won't offer.
Not comfortable at all
Very comfortable
Some of our volunteers are Moms too! Would you feel comfortable with your Volunteer(s) bringing their child(ren) on their visit? *
Please note: If you are comfortable with babies or children coming on a visit, the chances of getting a visit right away are better. Our volunteers would never visit a home if they or their children are sick.
Required
What are the best days to visit you? *
We will check with you prior to scheduling to ensure there are no appointments scheduled and that you are available. Please check all days that are possibilities for a visit. The more days you choose, the better chance of a sooner visit.
Required
What are the best time frames to visit you? *
We will check with you prior to scheduling to ensure there are no appointments scheduled and that you are available. Please check off all times that you are available. The more options you choose, the better chance of a sooner visit.
Required
Emergency Contact
Please list someone that you trust as your contact for volunteers to contact in case of an emergency.
Emergency Contact Name *
Emergency Contact Number *
Relation *
After your visit, one of our volunteers will reach out to you to see how you're doing. What method works best for you? *
What did we miss? Please tell us what us we should know:
Disclaimer: I understand that Birth and Beyond Resources, Inc. has taken multiple steps to choose the best volunteers for this program, and all MamaMoon volunteers have been interviewed and reference checked. However, I agree that Birth and Beyond Resources, Inc. is not responsible for the volunteers who are sent on a visit. I understand that all of the information given here, on a visit, and in the MamaMoon Support Group will be kept confidential and will not be discussed outside of the MamaMoon team, unless our volunteers feel I am suffering from a perinatal mood or anxiety disorder. I agree that if this is the case, it is best for a MamaMoon Leader to call my emergency contact so that they can ensure that I can get the help that I need. *
Required
We have strict policies and procedures for our volunteers. One of which is we are not allowed to conduct a visit if we or anyone in our house is sick. It's important to us that we don't share that sickness in a vulnerable household with a newborn. We also always visit with two volunteers. We feel these policies are important but as a result, visits can be postponed at any time (we are just as bummed to postpone!). Please note that we cannot require our volunteers to disclose their health information, such as vaccine status. Of course, some of our volunteers are vaccinated, and some wear masks but we cannot guarantee that these would be present for your MamaMoon visit. If you are uncomfortable with our volunteers not wearing masks or not disclosing their health information, please schedule a virtual MamaMoon instead. Visits can be scheduled quicker if you are comfortable with babies/children coming along or if you broaden the time frames/days that you are available. If we are unable to fill your visit within 2 weeks, we will contact you to convert your in-person visit to a virtual visit.  *
Required
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