Lactation Support Registration Form






Questions 6 - 11 are optional. Information is used to ensure adequate accommodations are available.









Bluegrass Community and Technical College offers breastfeeding women who work, or attend classes a private place to express their breast milk. Lactation Stations will be open when staff and students are present on each campus. Each user should review the Use and Release Statement and review the Orientation Packet for Breastfeeding Staff and Students before using the room.

Lactation Room Use and Release Statement

When using the lactation room I agree to observe scheduling and housekeeping procedures outlined below:

  • I understand the Lactation Station is open when staff and students are present on each campus.
  • I will leave the Lactation Station in order after using it and will report any problems to the program representative.
  • I am responsible for bringing my own personal pump, pump kit, and my own personal cooler to store and transport my own milk.
  • I understand that the average pumping time is 15-20 minutes. I agree to be considerate of others' schedules and not go over the time limit allowed at each station.
  • I understand that I have access to lactation stations on all BCTC campus sites, regardless of which campus I have designated as my main campus site.
  • I understand that the Lactation Station is a service provided for breastfeeding women who work and/or attend classes at Bluegrass Community and Technical College. KCTCS & Bluegrass Community and Technical College will not be responsible for any losses, injuries, or other damages that I might experience as a result of using the Lactation Station.