Birthing Center Class Registration Form

Birthing Center Class Registration Form

To register for any of the Birthing Center's classes, select the desired class (listed by the first session, if it is a series) and provide your contact information.

Prepared Childbirth 2010 (5-week series or 1-Day Saturday class)

January 5, 6:30 to 8:30 p.m. series begins
January 9, 9 a.m. - 5 p.m. (1-day Saturday Class)
February 6, 9 a.m. - 5 p.m. (1-day Saturday Class)
March 7, 9 a.m. - 5 p.m. (1-day Saturday Class)
March 9, 6:30 to 8:30 p.m., series begins
March 13, 9 a.m. - 5 p.m. (1-day Saturday Class)
April 10, 9 a.m. - 5 p.m. (1-day Saturday Class)
May 1, 9 a.m. - 5 p.m. (1-day Saturday Class)
May 4, 6:30 to 8:30 p.m., series begins
June 5, 9 a.m. - 5 p.m. (1-day Saturday Class)
July 6, 6:30 to 8:30 p.m., series begins
July 10, 9 a.m. - 5 p.m. (1-day Saturday Class)
August 7, 9 a.m. - 5 p.m. (1-day Saturday Class)
September 7, 6:30 to 8:30 p.m., series begins
September 11, 9 a.m. - 5 p.m. (1-day Saturday Class)
October 2, 9 a.m. - 5 p.m. (1-day Saturday Class)
November 6, 9 a.m. - 5 p.m. (1-day Saturday Class)
November 9, 6:30 to 8:30 p.m., series begins
December 4, 9 a.m. - 5 p.m. (1-day Saturday Class)

I wish to enroll in the following Prepared Childbirth class
(enter the starting date from list above)

Prenatal Refresher Class 2010 (5 to 8 p.m.)

February 16
April 13
June 8
August 10
October 12
December 7

I wish to enroll in the following Prenatal Refresher class
(enter the starting date from the list above)

Sibling Class
February 8, 2010
April 19, 2010
June 7, 2010
August 9, 2010
October 4, 2010
December 6, 2010

I wish to enroll my child(ren) in the following Sibling Class
(enter the date from above)

Names of children you are enrolling:
Child 1: age
Child 2: age
Child 3: age

Cesarean Section
Please contact me about arranging for a Cesarean Section class

Contact Information
Name:
Street Address
City:
State:
Zip:
Telephone:
Email Address:
Due Date:
Obstetrician/Midwife: