Legacy Member Form

Hey Mama! We’re updating our records to make sure we have the most current info for all our legacy members. Please complete the form below. Fields marked with * are required.

Where do you live? *

First name *

Last name *

Your e-mail address *make sure it's inputted correctly. *

Phone number (no spaces or dashes) *

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Whatsapp number (if different from above)

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How did you find out about Mamas Connect? *

If referred, please provide the first and last name of the existing member who referred you.

What topics are you most interested in exploring in our group? To make more than one selection, hold the CTRL button. *

What is your birthday (month/day only)? Providing this is optional — we use this to celebrate you in the group. Format: MM/DD

What is your age range? This helps us understand who we serve, plan relevant programs, and strengthen funding applications.

Where did you spend most of your childhood? This helps us design culturally relevant programming and strengthens grant applications for Black maternal health and community wellness.

If you selected Other, please tell us which region. This helps us understand the cultural backgrounds represented in our community.

How many children do you have? *

Please share the age(s) and gender (s) of your child(ren). (Short answer e.g., 4M, 2F, 7F) *

Do one or more of your children have a disability? *

Are you a single parent? *

Are you interested in volunteering with Mamas Connect to support events or community activities? Most involvement is casual and part-time. If yes or maybe, what skills or areas would you like to contribute? *To make more than one selection, hold the CTRL button.

We love celebrating and supporting the amazing talents within our community! Whether you have a business, a side hustle, or simply skills and passions you’d like to share, we’d love to know more. *Do you currently have a business or side hustle? *

What is your business or side hustle?

If your're interested in sharing your product(s) or service(s) with the group, which way(s) would you like to do so? *To make more than one selection, hold the CTRL button.

Don't have a business or side hustle? Do you have any skills, hobbies, or areas of expertise you’d be open to sharing with the group? If yes, please share below.

If you did answer the previous question, would you be interested in contributing in any of the following ways? *To make more than one selection, hold the CTRL button.

Would you like to receive our monthly newsletter with updates on events, parenting resources, and community highlights? *

Anything you'd like us to know? Please use this field to provide details to responses selected as 'Other'.

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