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: British ColumbiaAlbertaYukonNorth West TerritoriesSaskatchewanManitobaOntarioQuebecNewfoundlandNew BrunswickNova ScotiaPEINunavitNon-Canadian
Postal Code:
Email Address:
Day-time phone #:
Evening phone #:
Due-date (dd/mm/yy):
First Baby? YesNo
Please select a class from the drop-down menu below.
Class Dates: Private classes: (three 2-1/2 to 3-hour online video-conference sessions). Pls. call or email to arrange dates.Spring Workshop #2: Sundays, May 28th and June 4th PLUS Monday evening June 5th * ONLINE *Summer Workshop #1: Sundays, July 9th and 16th PLUS Monday evening July 17th * ONLINE *Summer Workshop #2: Sundays, August 13th and 20th PLUS Monday evening August 21st * ONLINE *Spring Series #1: Tuesdays, March 14th through April 25th. * ONLINE *Spring Series #2: Tuesdays, May 16th through June 27th. * ONLINE *Summer Series #1: Tuesdays, July 18th through August 29th. * ONLINE *
Preferred method of payment: PayPal (you do not need to be a PayPal member)Cheque (by mail)Email transfer
Payment for private classes is made at either the first or second session.
Where do you plan to give birth?HospitalHome
Choose hospital: ---Abbotsford Regional HospitalB.C. Women’s HospitalBurnaby General HospitalLangley Memorial HospitalLions Gate HospitalPeace Arch HospitalRichmond General HospitalRidge Meadows HospitalRoyal Columbian HospitalSt. Pauls HospitalSurrey Memorial 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?InternetDoctorMidwifeBrochureReferral from friend
Comments/requests: