Register for our Pregnancy After Loss Mentorship Program with Three Little Birds

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Congratulations on your pregnancy! We are excited to offer you a personalized program to support you through this excited, yet terrifying time. Our support groups are hosted weekly by Kristen Samuelson and Ashly Hannah, who have both experienced the tragedy of loss and the successful birth of our "rainbow babies".

Please complete the form below to register for our program materials.

Email *

First and last name
*

Current week's gestation
*

Names of other children (earthside and beyond) You can share as much or as little as you want!
*

Our office is open every Tuesday to support you, though it may not be realistic for you to attend each week. Doors open at 5 - come when you can...we know everyone works, traffic, etc. If you have to leave by a certain time that is ok too! It is an open door policy! We usually finish up around 8 PM. Meetings are open to all and free to attend. Can you commit to attending meetings on Tuesdays between 5 and 8 PM? *

Yes

I need to adjust my schedule

Required

Three Little Birds can offer you our Mentorship materials package. This includes:

- A copy of our Pregnancy After Loss Support Book/Journal - As our Nest Grows

- A copy of Pregnancy After Loss Support: Love Letters to Moms Pregnant After Loss by Emily Long

- Mama Bird Water Bottle

- One (1) private consult/reading with Kristen Samuelson

- Attendance at one Sneak Peek event at Wondertime and a complimentary "rainbow baby" photo with Desiree at Image is Everything Studios

A personalized gift

- Discounts to future special classes (childbirth after loss, parenting after loss, lactation support - not available until after Jan 2023).

- Free heartbeat Doppler rental

The cost of this package is $10/week ($320 total for 32 weeks).

Yes, I'm interested in paying cash weekly (will need to pay for weeks where not attending meetings)

Yes, I'd like to pay in a lump sum/payment plan via the donations page (put PAL Mentorship in memo)

Yes, but I cannot afford it all right now (its ok! we understand!)....can we adjust the package to my specific needs/weeks gestation?

Required

Please note, our program has changed. Through our paid program, you are eligible for attendance at one sneak peek event at Wondertime. This will include a complimentary rainbow baby photo of you and your partner through Image is Everything Studios. You will also be given a discount by both Community Partners to book future sessions at Wondertime or for maternity/newborn sessions at Image is Everything.
*

I understand

Required

Our meetings are during prime dinner time and we cannot have hungry mamas or babes. What would you prefer?
*

I will eat before I come/after I leave

I'll provide my own meal

Can we order from the pizza place next door?

I'm interested in paying $10/week additional if a meal is provided.

Required

Currently, how are you feeling? You can share as much or as little as you want but the more you provide, the better we can serve you. Trust us, we have been there and your feelings are real!
*

Currently, how is your partner feeling? Partners are also welcome to attend meetings!

Anything else you want to share/ask? Add it here and we will discuss at the next meeting!

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms