English Breastfeeding Registration Form

English Breastfeeding Registration Form -Baby Wearing Basics

Welcome Baby Durham 721 Foster St. Durham, NC 27701
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*

MonthDayYear
Date
E-mail
example@example.com
Phone Number*
Format: (000) 000-0000.
YesNo
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:*
MedicaidWICNeither
Please select your income for the last 12 months*
Which Best describes your household?*
UnemployedEmployed part timeEmployed full timeSeasonal WorkerTemporary EmploymentPrefer not to anser
High School Diploma/GEDDid not complete High SchoolSome College2 year college graduate/AA4 year college graduate/BA, BSPrefer not to answer
How Many children under 18 are living in the home? blanks*
YesNoYes with twins
If you are expecting, what is your due date?*

MonthDayYear
Date

English Breastfeeding Registration Form -Baby Wearing Basics