registration 1

Physician's Name *

Please choose one class session *

Prepared Childbirth Education Class Series- January 10-17-24-31Breast-feeding class- June 14
Prepared Childbirth Education Class- February 4Breast-feeding class- July 12
Prepared Childbirth Education Class Series- March 6-13-20-27Newborn Care Class- January 31
Prepared Childbirth Education Class Series- April 3-10-17-24Newborn Care Class- March 27
Refresher Childbirth Education- January 17Newborn Care Class- April 24
Refresher Childbirth Education March 13Sibling Class- February 13
Refresher Childbirth Education April 10Sibling Class-April 9
Breast-feeding class- January 12Sibling Class-June 11
Breast-feeding class- February 9Sibling Class-August 14
Breast-feeding class- March 8Sibling Class-October 8
Breast-feeding class - April 12Sibling Class-December 10
Breast-feeding class- May 10

First Name *
Last Name *
Email Address *
Phone Number *

Address *
Physician's Name *
Due Date *
Please choose one class session *	Prepared Childbirth Education Class Series- January 10-17-24-31Breast-feeding class- June 14 Prepared Childbirth Education Class- February 4Breast-feeding class- July 12 Prepared Childbirth Education Class Series- March 6-13-20-27Newborn Care Class- January 31 Prepared Childbirth Education Class Series- April 3-10-17-24Newborn Care Class- March 27 Refresher Childbirth Education- January 17Newborn Care Class- April 24 Refresher Childbirth Education March 13Sibling Class- February 13 Refresher Childbirth Education April 10Sibling Class-April 9 Breast-feeding class- January 12Sibling Class-June 11 Breast-feeding class- February 9Sibling Class-August 14 Breast-feeding class- March 8Sibling Class-October 8 Breast-feeding class - April 12Sibling Class-December 10 Breast-feeding class- May 10
If Sibling class is selected please add name and ages of children