English Breastfeeding Registration Form

No carrier? No problem. Welcome Baby can offer a soft carrier or buckle carrier while supplies last. Because donated items are limited, please bring your own carrier or wrap if you have one.

Your first & last name as it appears on your Identification

First NameLast Name

Birth Date

Date

E-mail

example@example.com

Phone Number

Format: (000) 000-0000.

Have You been to the Welcome Baby Support Group within the past 12 months?

No additional steps are needed. Press submit to finalize your RSVP for the Baby Wearing Basics class on Monday, 5/18/2026, 10–12pm at Welcome Baby.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Please select an ethnicity:

Please select your Race:

Are you receiving? Please check all that apply

Please select your income for the last 12 months

Which Best describes your household?

Current Employment Status

Education:

How Many children under 18 are living in the home? blanks*

Are you Expecting?

If you are expecting, what is your due date?

Date

List your children that are under the age of 5 years old:

Rows	First name of Child	Gender Male/ Female	Date of Birth
Child 1
Child 2
Child 3
Child 4

English Breastfeeding Registration Form -Baby Wearing Basics