TRI-CAP | Community Action - Helping People. Changing Lives. Healthy Families Free Gift »

Free Gift for your baby!

Receive a free gift for your newborn along with parenting information and resources available to families in your community.

Mother's Name

First

Last
Date of Birth

Date Format: MM slash DD slash YYYY
Address

Street Address

Address Line 2

City

State

ZIP Code
County
Phone
My Due Date

Date Format: MM slash DD slash YYYY
My Newborn's Date of Birth

Date Format: MM slash DD slash YYYY
Marital Status
Please check the services you are currently benefiting from:
- WIC
- Food Stamps
- TANF
- Medicaid
- SSI/SSPI
This form will be forwarded to the appropriate Healthy Families office in the county in which you reside.