I understanding Breastfeeding Support also known as "Precious Jewels Nursing Mothers Club (tm)" is led by a Board Certified Lactation Consultant who is also an Ordained Minister.

I understand the group gathers monthly for two hours.

I understand the group Precious Jewels Nursing Mothers Club is a service provided by Precious Jewels Moms Ministries, a Christian non for profit. Therefore, I will be offered or can inquire for optional prayer, baby blessing and other religious sacraments at the conclusion of the breastfeeding group service. 

I give my consent for the lactation consultant to work with me and my baby during this brief group consultation to verbally answer my breastfeeding concerns or questions. 

I understand that this group lactation consultation session is for information purposes only and NOT intended to for complex breastfeeding difficulties, nor to provide assessment of breast or breastfeeding problems of mom or baby.

 I understand this is a group breastfeeding support information session only. There may be other mothers with babies who have similar breastfeeding questions present. Information shared among group members is confidential and not to be shared out the group by person name. 

I understand that I will have a medical grade scale to weight my own baby at my own risk with the purpose of knowing my breastfed baby weight gain.

I understand this breastfeeding support group is NOT for complex breastfeeding difficulties such a poor infant weight gain, low milk supply, difficulty latch beyond week 3. A referral to an outside Lactation Consultant will be given.

I give my consent for the Lactation Consultant to use clinical information during our group session for education of other health care providers and mothers about lactation. I will not be identified in anyway, but aspects of my situation may be described and discussed.

I understand there may be students and other volunteers present.

I understand this breastfeeding support group requires a $15.00 group lactation consultation fee each month of attendance.

I understand if I am on WIC I can make a donation of any amount to attend and I will not be turned away for failure to pay. 

I understand total payment is expected at the beginning of the group session. I will receive an invoice to submit to my insurance company for consideration of reimbursement.