The Lactation Room Rules and Participation Agreement outlines the guidelines for using the facility respectfully, ensuring a clean, safe, and supportive environment for nursing individuals. I, Name , have received and reviewed the guidelines for the use of the Twin Towers Lactation Room and have had an opportunity to ask questions and have had them answered to my satisfaction. I will begin using the Lactation Room for an approximate period of Number of Months months for the designated purpose of expressing my breast milk, beginning on or about the date of Start Date I understand that Lactation Room access is granted solely for lactation purposes and that I am responsible for the following: bringing my own breast pump and supplies; sanitizing the countertop, sink and other surface areas before and after expressing milk; cleaning up any spills or other untidiness created during use of the room; contacting designated personnel in the event of a spill; securing the room after each use when applicable; respecting the privacy of other lactation room users; and notifying the Georgia Department of Administrative Services (DOAS) when access to the Twin Towers Lactation Room is no longer needed. I understand that I will have access to and may utilize the refrigerator in the Lactation Room for the storage of expressed breast milk. If I elect to use the refrigerator to store expressed breast milk, I understand the following: I am required to label my milk with my name, department, telephone number and the date the milk was expressed. I am required to remove all my stored breast milk by end of business each day. Stored milk that has not been removed by the end of the business day may be disposed of. I am responsible for ensuring that the refrigerator is always kept clean. DOAS and the Georgia Building Authority (GBA) are not responsible for the contents of refrigerator or any loss of or damage to my stored breast milk. I understand that: I should not leave any personal items or equipment in the lactation room. I should not store food or drink in the refrigerator. Ice packs, containers or other accessories are not provided; therefore, it is my responsibility to furnish these items. I understand that failure to comply with any of these provisions could be grounds for denying me further access to the lactation room. Participant Name Date Phone Number Email Employee ID (if applicable) Agency - Select - Abraham Baldwin Agricultural College ACCG Administrative Office of the Courts Albany State University Albany Technical College Armstrong State University Athens Technical College Atlanta Metropolitan College Atlanta Technical College Augusta Technical College Augusta University Bainbridge College, Ben Hill County School District Board of Regents Central Georgia Technical College Chattahoochee Technical College Clark Atlanta University Clayton State University Coastal Pines Technical College College of Coastal Georgia Columbus State University Columbus Technical College Council of Superior Court Judge Criminal Justice Coordinating Council CSB-Albany Area CSB-Avita Community Partners CSB-Clayton CSB-Cobb-Douglas CSB-Dekalb CSB-Georgia Pines CSB-Highlands Rivers CSB-Lookout Mountain CSB-McIntosh Trail CSB-Middle Flint CSB-Middle Georgia CSB-New Horizons CSB-Oconee CSB-Pathways Center CSB-Pineland CSB-River Edge CSB-Serenity BHS CSB-South Georgia CSB-Unison Behavioral Health CSB-Viewpoint Health Dalton State College Darton College Department of Agriculture Department of Audits and Accounts Department of Banking and Finance Department of Behavioral Health Department of Community Affairs Department of Community Health Department of Community Supervision Department of Corrections Department of Defense Department of Driver Services Department of Early Care & Learning Department of Economic Development Department of Education Department of Human Services Department of Insurance Department of Juvenile Justice Department of Labor Department of Law Department of Natural Resources Department of Public Health Department of Public Safety Department of Revenue Department of Transportation Department of Veterans Services DOAS East Georgia College Employees Retirement System of Georgia Fort Valley State University Fulton County Gateway Behavioral Health Services GEMA Georgia Aviation Authority Georgia Building Authority Georgia Bureau of Investigation Georgia College & State University Georgia Commission on Equal Opportunity Georgia Commission on the Holocaust Georgia Correctional Industries Georgia Council on Developmental Disabilities Georgia Development Authority Georgia Drugs and Narcotics Agency Georgia Environmental Facilities Authority Georgia Environmental Finance Authority Georgia Firefighter Standards and Training Council Georgia Forestry Commission Georgia General Assembly Georgia Government Transparency and Campaign Finance Commission Georgia Gwinnett College Georgia Highlands College Georgia Institute of Technology Georgia Lottery Corporation Georgia National Fairgrounds & Agricenter Georgia Northwestern Technical College Georgia Perimeter College Georgia Piedmont Technical College Georgia Ports Authority Georgia Professional Standards Commission Georgia Public Defenders Standards Council Georgia Public Telecommunications Commissions Georgia Real 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Child Advocate Office of the State Inspector General Office of Treasury & Fiscal Services Ogeechee Technical College Prosecuting Attorneys’ Council of Georgia Public Safety Training Center Public Service Commission Savannah State University Savannah Technical College Secretary of State Senate Budget and Evaluation Office Soil & Water Conservation Commission South Georgia State College South Georgia Technical College Southeastern Technical College Southern Crescent Technical College Southern Polytechnic State University Southern Regional Technical College Southwest Georgia Technical College State Accounting Office State Board of Pardons and Paroles State Board of Worker's Compensation State of Georgia Peace Officer Standards and Training Council State Personnel Administration State Road and Tollway Authority Stone Mountain Memorial Association Subsequent Injury Trust Fund Teachers Retirement System of Georgia Technical College System of Georgia The Judicial Council Of Georgia University 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