"*" indicates required fields

I am a:*
Have you registered with Care Net of Central Texas before?
Event City*
We host this event in various cities. Select which one you'd like to be notified about! (You don't have to live there).
Which of these best describes your relationship to the child under 3?*
Date of birth of your youngest child?*
Was your youngest chld's birth weight less than 5 lbs. 8 oz.?*
Was your youngest child born preterm (before 37 weeks)?*
List each child's date of birth and sex on one line.
Are you a U.S. citizen or eligible for Medicaid?*
Do you have access to a device for virtual meetings (Zoom)?

NOTE: Once you submit this form, you'll be taken to a page to sign up for a free educational Zoom class! If you attend one of the two amazing pregnancy/parenting classes we send you, you'll be qualified to come and pick up your items!
Name*
Your Date of birth*
By giving us your phone number, you consent to reminder texts about the event you signed up for in accordance with these terms: slkt.io/Z3c6
What city, or general area?
Sex*
Marital Status*
Highest education completed*
Ethnicity*
For example: Size 3 diapers, 6-9 mo boy clothes, Infamil Gentlease
SPIRITUAL PREFERENCE
Among the many services we can provide you, some can help you with your spiritual health. For example, if you find comfort in prayer, someone here can pray with you, if you’d like. We offer spiritual services because they’re a part of our faith background. However, we will not offer to provide you spiritual services if you don’t want us to. All of the other services we provide are still here for you, even if you decide not to receive spiritual help. If you are open to receiving spiritual services, I will introduce you to another counselor here who will provide these services to you. And, if you prefer not to receive any services - spiritual or otherwise - from us, we will help you find another provider of your choice. Please check your preference below*
How did you hear about this event?
This field is for validation purposes and should be left unchanged.