Waitlist- Postnatal Services / Baby & Me

Title *

Today's Date: *

Full Name (First and Last): *

Email Address: *

Phone Number: *

Which of the following program(s) are you interested in joining the waitlist for? *

Baby & Me Program TUESDAYS, 10:45am-12:45pm | OLIVET CHURCH, 613 QUEENS AVENUE, NEW WESTMINS

Baby & Me Program THURSDAYS, 12:45pm-3pm | EDMONDS RESOURCE CENTRE, ROOM 104, 7355 CANADA WAY, BURNABY

Please note this waitlist is for postnatal clients only and for those with infants under 6 months of age. If you are looking for prenatal services, please join our other waitlist.

Did you attend our BFL's prenatal program? *

Do you require child care for your other children while attending the program? *

Free child care available for children 18 months to 10 years with pre-registration.

If you require child care services, how many children do you need care for while you attend the program?

Please indicate how you were referred to the program? *

Please indicate where you currently live? *

All clients must live in Burnaby or New Westminster to participate in our programs at this time. Please visit https://www.bcapop.ca/ for other POPs programs in your area.

Please indicate your current age range. *

Date of Birth: *

Baby's Age: *

Please note our Baby & Me program is a support group for mothers experiencing emotional, social, financial and health challenges with infants 0-6 months. For programs for baby's older than 6 months, please email bfl_info@burnabyfamilylife.org.

Was this your first pregnancy? *

Please indicate why you are interested in attending this program. *

Please indicate which of the following issues/ barriers you may face. *

What are some of the resources you hope to access in the program? *

Estimated Annual Income: *

Anything else you want to tell us?

The below are for BFL Admin only to complete.

ADMIN ONLY: Exit Waitlist

ADMIN ONLY: Reason for Exit

ADMIN ONLY: Notes

ADMIN ONLY: Date of Exit

ADMIN ONLY: Move to Intake *

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