WHEPMom Application

Thank you for your interest in the Women’s Health Education Program. Please complete the form below and we will be in touch with you within 2-5 business days.

Best way to contact you

Call Text Email

Completed Grade/Degree

How many individuals live in your household (Ages 0-100)

Are you pregnant?

yes no

Do you have children?

yes no

Do you have a crib/bassinet for your expected child or newborn?

yes no

Are you receiving WIC or are you WIC eligible?

yes no

How did you hear about us?

Hold Harmless and Release Agreement

By submitting this form, I agree to indemnify, defend and hold harmless the Women’s Health Education Program and P2i Global Foundation, as well as staff, employees, officers, agents, interns and volunteers of any claims or losses resulting from my participation in any events, workshops, camps or meetings that I plan to attend. I give WHEP all the right to interview and/or take photographs, audio and audio-visual recordings of myself and/or my child to be used in promotional, educational and fundraising materials. I acknowledge that WHEP shall have all rights of copyright to such photographs and videotapes.

Please enter your FULL NAME to accept this agreement and submit the form

About

The Women’s Health Education Program (WHEP) of the P2i Global Foundation is a not-for-profit organization, organized under the laws of Ohio, recognized under section 501(c)(3) of the Internal Revenue Code.

Get in Touch:

whep@whepohio.org