Registration Form
The Stork's Nest program is a partnership between Zeta Phi Beta Sorority and the March of Dimes. The program is an incentive based, prenatal health promotion program for pregnant women in with low income.  Stork's Nest encourages pregnant women to make and keep prenatal care appointments as well as participating in prenatal education classes. Participants earn free items thru completing the program as well as attending workshops.
Email *
Date *
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Last Name, First Name *
Phone number *
Address
Are You Currently Pregnant
Are you a parent of a child under the age of 24 months
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WISH LIST:
We want our families to be successful, a parent who attends our classes can earn supplies that helps them prepare for the new baby. Please if you need any of the following maternity or baby care items. 
How did you learn about the Storks Nest program? *
A copy of your responses will be emailed to the address you provided.
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