Georgia Tech Nursing Moms Program Agreement and Registration Form

I have read and understand all of the provisions of the Georgia Tech Nursing Moms Program Policy. I understand that in order to use the pump, I must comply with this agreement and purchase my own personal adapter kit. I understand further that my participation in the program is subject to space availability.

I agree to abide by all provisions of the Georgia Tech Nursing Moms Program Policy. I understand that failure to comply with any of these provisions could be grounds for my termination from the program. I agree that if I encounter any problems with the pump, or if I have any concerns about the pump’s operation, I will contact Sandra Duplessis at 404.385.3686. I agree that the storage and transport of my expressed breast milk is my own responsibility.

Map of Georgia Tech

Georgia Institute of Technology
North Avenue, Atlanta, GA 30332
Phone: 404-894-2000