2024 Baby Shower Registration

Welcome to the registration for the upcoming Baby Shower to celebrate you and your bundle of joy. This event is sponsored by Good Samaritan Trauma Services, made possible by a Grant funded by Toyota of Indiana. At this baby shower, we will play games, eat cake and best of all, receive a bundle of gifts all designed for the safety and comfort of your little one. Due to space limitations, we will be limiting attendance to 30 second or third trimester expectant mothers plus 1 selected guest, so bring along Dad, Grandma, Babysitter or any other adult that will be caring for your baby in the first 12 months.

Appointment*

Name of Expectant Mother*

First NameLast Name

Birthdate of Expectant Mother*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Please list your plus one and their role in the baby's life

(example: John Smith, Father)

Plus One Name

First NameLast Name

Plus One's Role in Baby's Life

How many weeks into your pregnancy are you?*

1 - 12 weeks13 - 26 weeks27 - 40 weeks

Is this your first child?*

YesNo

Are you receiving prenatal care?*

YesNo

Current OB/GYN

Hospital in which you plan to deliver your baby*

Good SamaritanOther

Where will you be delivering your baby?

Are you currently enrolled in WIC or receiving aid from any other family planning organization?*

Yes, WICYes, Other (please list)No

Please list