Select Class and Date: Six Week Class, Tuesdays 6-9pm Jan 10 - Feb 7 April 17 - May 15 July 24 - Aug 21 Six Week Class, Sundays 11am-2pm Feb 26 - March 25 May 27 - June 24 Sept 16 - Oct 14 One Day Sessions, Saturday 12:30-5pm February 11 April 7 June 2 Breastfeeding Classes, Saturday 10:30am-12pm February 11 April 7 June 2
Mother's name: Mother's Birth Date:
Partner/Support Person's name:
e-mail address:
Phone: Cell:
Address, City, Zip:
Care Provider: Due Date:
Number of previous births:
Attended childbirth classes before: Yes No
Do you have any special concerns regarding your pregnancy:
