Mothers Nursing Suite, Usage Request & Locker Checkout Form

I am requesting to have access to the Mother's Nursing Suite. I agree to adhere to the guidelines for the Suite and understand that failure to do so will result in suspension of my use of it. I agree to keep the security code confidential and I will not give the code to any other person. I understand that if I choose I can request to check out a locker. If I do, I accept responsibility for it and the lock and acknowledge that I will pay a $25 fee if the lock is lost. Completion and submission of this form indicates my agreement to follow the guidelines and to accept any risk associated with the use of the Suite. Note: Alumni who are doing residency training in the Kirksville area and their spouses/partners may use the Suite.
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