EmpowerHER: Uplift Black Mothers Program Registration

Welcome to EmpowerHER — a program created to walk alongside you through pregnancy, birth, and postpartum with care, encouragement, and support. Each mother or birthing person is paired with a trained doula who provides personalized guidance, advocacy, and comfort every step of the way. Services include birth planning, prenatal education, continuous labor support, postpartum recovery assistance, newborn care education, breastfeeding and feeding support, and mental health check-ins. EmpowerHER also connects families with community resources, provides an EmpowerHER Baby Bag filled with essentials and information, and offers group workshops to build community with other parents. Our goal is to ensure every mother and birthing person feels confident, supported, and empowered throughout their birthing journey and beyond.

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* 1. Full Name

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* 2. When is your birthday?

Date of Birth

Date

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* 3. Phone Number

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* 4. Email Address

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* 5. Preferred Contact Method

Phone call

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* 6. Expected Due Date

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* 7. What is your gestational age in weeks?

1-10 weeks

11-20 weeks

21-30 weeks

31-40 weeks

Over 40 weeks

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* 8. Is this your first pregnancy?

Yes