Kangaroula Services Application
This is an application and does not ensure that you will be granted Kangaroula services. Birth Parents must plan to give birth within the city of Los Angeles. BIPOC identifying parents birthing in the hospital setting will be prioritized.

We are looking for four expecting parents who are in need of Kangaroula services during and after their birth in a home or hospital setting within Los Angeles County.
We’re offering services to:
One parent expecting to deliver in December 2021
One parent expecting to deliver in January 2021
One parent expecting to deliver in February 2022
One parent expecting to deliver in March 2022
Services are limited to a first come, first serve basis
Selected parent participants will be notified by the end of November 2021

For more information about the Kangaroula visit www.kangaroula.com and www.ninobirth.org 

For more information on Chichihualtia Perinatal & Family Wellness and our Kangaroula services visit www.chichihualtia.org 

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Email *
Full Name *
Phone Number *
Email Address *
What is your zip code? *
When is you estimated due date? *
Do you identify as Black, Indigenous, or person of color?
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Are you expecting to deliver at a hospital? If so which one?
Are you expecting to deliver at a birth center or at your home? What is the zip code of the location?
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