Centering Joy Maternal Health Attendee Registration Form
The Centering Joy Maternal Health Expo and Community Baby Shower is a free event designed to support expecting and new mothers in Rock Hill, SC, and surrounding areas by providing resources, education, and essential baby items. The last day to register is June 20, 2025. Date: Saturday June 28th, 2025 Time: 10:00am- 3:00pm Location:The Nesting House RH 2211 Myers St, Rock Hill, SC 29732
Attendee Information
Please fill name and contact information of attendees.
Your Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Age
*
Under 18
18-24
25-34
35-44
45 and Up
Ethnicity
*
African American/Black
Caucasian/White
Hispanic/Latino
Asian/Pacific Islander
Native American
Other
Please select the county that you live in
*
Please Select
York County
Lancaster County
Gaston County
Chester County
Mecklenburg County
Other
Please list your zip code
*
Number of Children
*
1
2-3
3-5
5 or More
Other
Current prenatal status
*
Pregnant
Recently gave birth (within the last 6 months)
Parenting a child under 2 years old.
N/A
Do you currently have a doula or a birth support person?
*
Yes
No
Are you interested in receiving information about:(Select all that apply)
*
Doula Services
Breastfeeding/ Lactation Support
Postpartum Support
Mental Health Resources
Medicaid/ Insurance Navigation
Childbirth Education Classes
Would you like to be updated about the upcoming events?
*
Yes
No
Is this your first time attending a maternal health event?
*
Yes
No
What are you most hoping to gain from the event:(Select all that apply)
*
Education and Information
Resources and Referrals
Community and Support
Connection with other moms
Opportunities to get involved
Is there anything else you would like us to know to best support you?
*
Consent
*
I consent to receive event updates and resources related to maternal and infant health.
I consent to having event photos/videos taken during the event (for promotional use).
I do not consent to the above.
Submit
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