Enroll in Healthy Parents & Babies, an Early Head Start Program

Healthy Parents & Babies Initial Contact Form

Thank you for your interest in enrolling your child in Healthy Parents & Babies. To get started in the enrollment process, please complete this initial contact form and someone will be in touch with you within 3-5 business days.

Note: Income is an eligibility requirement for our Early Head Start programs.

See Eligibility Guidelines

Primary Parent or Guardian Information

First Name

Last Name

Phone Number

What is the best way to reach you?

What is the best time to reach you?

Zip Code

By providing your zip code, we are able to share resources and program referrals relevant to your location.

What is the primary language spoken at home?

How did you hear about Start Early's Healthy Parents & Babies programs?

Please share the name of the community agency.

Please share the name of the parent or friend who referred you to Start Early.

Other (please specify)

Services for Pregnant Women

Are you pregnant?

YesNo

Is your pregnancy high risk?

YesNo

What is your expected due date?*

Month

Day

Year

Services for Children Under Age 3

Do you have a child or children that you would like to enroll in Healthy Parents & Babies?

YesNo

Child's First Name

Child's Last Name

What is your child's birthday?*

Month

Day

Year

If you are enrolling more than one child, please click "enroll another child" to include their information.

Have additional questions or comments? Add them here.

If you have additional questions, please email HPB@StartEarly.org.

Quality early childhood is one of the best ways to level the playing field. Learn why and about the impact we’re having.

For 40 years, Start Early has been a champion for early learning. Learn more about what has shaped us and what moves us forward.

We bring our expertise across program, policy and research to all we do and partner with others to scale our knowledge across the country.

Strengthening early childhood organizations for positive staff, family, and child outcomes.

Resources from our experts that give parents the tools they need to help their children thrive in those critical early years.

Become a champion for early learning. Learn how you can help close the opportunity gap for our youngest learners.

Healthy Parents & Babies Initial Contact Form