Class Registration Form

Please complete the form in full and submit it along with your payment for the class you wish to attend. If registering for more than one class please insert the combined cost in the "Other Amount" field of payment portion of form.

All class fees are non-refundable.

Full Name *

Address *

City *

State *

Postal code

Cell Phone *

Class Date *

Class Location (City) *

Due Date *

Estimated Due Date

Email *

Support Person's Name *

Checkbox Class Options *

Express Childbirth Class $275

Life w/ New Baby & Online Breastfeeding Class $155

Hospital Birth Class $395

Home/Birth Center Class $375

Instagram handle

How did you hear about us? *

Personal Referral

Google

Facebook

Instagram

Event

Other

If patient is under 18 years of age, enter guardian information below.

Guardian Name

Guardian Phone

Class Payment *

$ 275

$ 375

$ 395

$ 155

Other amount

*100% secure & safe payments*

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