Mom Power Interest Form
Corner Health Center
Spring 2023 registration is now closed. Please fill out this form if you are interested in joining a future session.
Mom Power is a parenting program for moms and their children. Parents will learn about building healthy relationships with their kids, figuring out the “why” behind their child’s behaviors, and important self-care skills in a fun, relaxed group setting. Childcare, snacks, and transportation are provided. The participating parent must be 25 or younger at the time of registration. Expecting moms are also welcome. Masks are required for all adults and older children at this time. Fill out the form below and a member of the Mom Power team will contact you with more information once the next Mom Power session is scheduled.
Participant/Parent name
First Name
Last Name
Participant/Parent age (must be 25 or younger)
Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email
example@example.com
Names and ages of children who will attend. Due date if you're expecting.
Any food allergies or other information you want us to know?
Will you need a ride to the Corner for meetings?
Yes, always
Yes, sometimes
Maybe
No, never
What type gift card would you prefer? You can pick more than one if more than one works well for you.
Meijer
Kroger
Target
Thank you!
Contact Nicole at 734-714-2226 or nbongers@cornerhealth.org with any questions
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