Fifth Ward Chamber of Commerce Community Baby Shower Registration

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Sign-up form to participate in Fifth Ward Chamber of Commerce Community Baby Shower

You must be available to pick up items from Hester House (2020 Solo Street, Houston, TX 77020). One (1) child per registrant.

First Name *

Last Name *

Date of Birth (of registrant) *

YYYY

Number of People in Household (including self) *

Greater than 10

Economic Status *

I receive government assistance with grocery purchases (such as SNAP, WIC or TANF)

I have children that receive free or reduced lunch during the school year

My income is below $1,300.00 a month and I am eligible for other assistance programs.

I don't identify with any of the above but am experiencing a recent hardship.

I am not eligible for any of the above assistance programs due to my citizenship status but am experiencing a hardship.

The best way to contact me is by: *

Phone Call

Text

My phone number is: (please list the best way to contact you if you do not have access to a phone) *

My email address is: (Please leave blank if you do not have one)

Infant & Baby Categories. (Please select one (1) from the categories below)

Newborn to 6 months

Infants (7 months to 12 months)

2 years (13 months to 24 months)

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