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Please fill out this form to complete your lactation room request.
Date of request
Name (First Last)
OU Email
Day Time Phone Number
OU ID (not 4x4)
Start Date Needed
Approximate End Date
I understand the following:
I understand that I will have access to a multi-user, hospital grade Medela breast pump. I understand that I am responsible for bringing my own collection kit and storage containers if I choose to use the pump.
I understand that the storage and transport of my expressed breast milk is my own personal responsibility.
I understand that I should tidy the room after use and wipe up any spills before leaving the room. I will not leave pump parts or personal items in the room.
I understand that the average pumping time is 15 - 30 minutes and will make reservations before using the room.
I agree that if I encounter any problems with the Lactation Room I will notify OU Health Services as soon as possible.
I understand and agree that I shall be personally responsible for any and all property damage caused during the time I occupy the Lactation Room.
I understand the statements above
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