September 20th Online Bradley Method Series
To register for the classes from Sept. 20th - Dec. 6th, please fill out the form below.
Your Due Date
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Mother's Name (First and Last)
Mother's Occupation
Mother's Phone
Mother's Email
Coach's Name ( First and Last ) [your partner or the person attending class with you]
Coach's Occupation
Relationship with Coach (partner, husband, wife, mother, etc.)
Coach's Phone
Coach's Email
Which email do you want me to use for class communication and updates?
Clear selection
Address (Street, Apt. #, City, and Zip please) I am unable to get your Student Workbook from the Academy without this info. Thanks!
Birth Attendant's Name (Midwife, OB)
Where are you planning to give birth?
Besides the medical team, who else will attend the birth?
Are you planning to breastfeed your baby?
How is your health status?
Do you exercise regularly?
Clear selection
If yes, what do you do?
Have you had any problems with this pregnancy?
Does anyone in your household smoke?
Do you have other children? If yes, please write down their names and ages as well as any special information you would like me to know about their births.
What are you are hoping to experience for your birth?
What would you like to get out of this class?
Do you have any special concerns, fears, or circumstances you would like me to know about so that I can be sure to meet your needs during this course? (Please be assured that anything you write is confidential and will not be shared with anyone.)
How did you find out about this course?
Thank you for filling out this registration form. I will be in touch with you soon! Warmest, Susan
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