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Registration Form
What are you registering for?
Birth and Beyond
Refresher
Baby and Beyond
Other
Mom's name
*
First Name
Last Name
Partner's name
First Name
Last Name
Email
*
Phone
(###)
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Address
Provide zip code
May I text you at that number?
Yes
No
Care provider
OB, Midwife, Doula, etc.
Intended place of birth
Due date
MM
DD
YYYY
How did you find me?
What birth is this for you?
1st, 2nd, 3rd, etc.
Briefly describe your previous births
If applicable
What do you want to know? Learn? Experience? Prepare for?
Do either of you have any food / drink restrictions / allergies or sensory issues?
What day(s) and times work best for you to meet?
Classes typically take place on weekday evenings, Sundays, or occasionally Saturdays
Would you like to receive a quarterly newsletter?
Yes
No
Thank you!