Hey beautiful mama, thanks so much for your booking.

– Liz Johnson

If you could kindly complete the below form and social media release to complete your booking, it would be greatly appreciated.

In accordance with QLD government regulations, to access a Mothers Connected group, you are required to be double vaccinated. We appreciate your understanding and cooperation as we navigate these challenging times together.

For any assistance or general enquiries, don’t hesitate to contact Mothers Connected Founder, Liz.

Name

First Name

Last Name

Baby's Name

First Name

Last Name

Baby's DOB

Phone

(###)

###

####

Coffee Order for Mama

Any Dietary Requirements

Where possible, alternatives will be offered.

Can We Use your Name?

If Yes, Name Preferred?

What is Your Facebook Handle/Name?

To be included in the Mothers Group chat.

Where Did You Hear About Mothers Connected?

If Other, Please State

Please Tick

I authorise and grant Mothers Connected to take my photo regarding my experience with them.

I grant permission to Mothers Connected to use my photos on Facebook and Instagram or any other social media platform.

I authorise that Mothers Connected can edit, copy and distribute photos on social media for advertising and marketing purposes.

I agree that the photos belong to Mothers Connected.

I understand that I will not receive any monetary compensation.

I agree and understand that in accordance with QLD government regulations, to access a Mothers Connected group I am required to be double vaccinated.

Date and Initials

Please initial and date your agreement to the above social media release form.