Milk + Honey B.E.E.S.
Thank you for interest in our collective.

Please fill out the form below for a chance to be chosen for the Spring 2022 Milk + Honey B.E.E.S. ambassador. I am currently accepting two applicants for those who identify as a Black mother. At this time we are only accepting surrounding metro Atlanta residents and you must have a due date between by April 1, 2022 to apply. Registration closes on March 1, 2022. Selected Honeybees will be notified on March 5 by email so please turn on your notifications.

Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
How long do you want to breast/chest feed? *
Are you the first to breast/chest feed in your family? *
When is your due date? *
MM
/
DD
/
YYYY
If you are chosen do you consent to the lactation services provided with this club? *
What do you anticipate about your postpartum that may make you anxious about breastfeeding? *
If no, are you interested in childbirth education in the future? *
Phone *
Address *
What are your breast/chest feeding goals? *
Will you be returning to work or school within three months? *
Where will you be delivering? Please list the name of the hospital, midwifery practice or birth center you will be using? *
Will you be able to take the required virtual group breastfeeding class on Saturday March 19, 2022 at 10am? *
Will you be using a doula? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms