I have read and understand all of the provisions of the Lactation Room Guidelines. I understand that in order to use a provided pump, I must comply with these guidelines and purchase my own personal adapter kit. I understand that my participation in the program is subject to space availability.

I agree to abide by all guidelines of the Georgia Tech Lactation Room Program. 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 Candice Bovian at 404.894.0490. I agree that the storage and transport of my expressed breast milk is my own responsibility.

Georgia Tech Lactation Room Agreement Form