Harbor Area Healthy Families Inquiry Form Your name * First Name Last Name Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred method of contact * Email Phone call Text How old are you? How old are your children? Are you pregnant or expecting a child? * Yes No What are you looking for help with? Check all that apply. Housing assistance Parenting skills Education Resources (clothing, food, diapers, etc) Domestic violence resources Independent Living Skills (cooking/budgeting) Vocational Skills (school/job search/interviewing) Meeting other parents like me Building my support system Parent-child activities Accessing government resources Other Thank you!
