Registration Form

Please complete the following information for our class list.
Your information will not be shared with any outside parties.

Mother's first name:

Mother's last name:

Partner's first name:

Partner's last name:

Address 1:

Address 2:

City:

Province:

Postal Code:

Email Address:

Day-time phone #:

Evening phone #:

Due-date (dd/mm/yy):

First Baby?

Please select a class from the drop-down menu below.

Class Dates:

Preferred method of payment:

Payment for private classes is made at either the first or second session.

Where do you plan to give birth?

Choose hospital:

Other hospital:

Plans for your birth?

Doctor or Midwife's name (or name of practice):

Medical complications (if any):

How did you find these classes?

Comments/requests: