Hybrid Class Registration
Professionally filmed Online Class(es) with Live Virtual Support

Each student will receive the class appropriate workbook along with personalized class handouts used during in-person classes.

Contact us at for further information at (763) 498-1098 or DoulaMaeServices@gmail.com
PREGNANT/BIRTHING PERSON INTAKE
First & Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Mailing Address *
Your answer
Birthing Persons Date of Birth *
MM
/
DD
/
YYYY
Estimated Due Date *
MM
/
DD
/
YYYY
Intended Birthing Location *
Your answer
Provider *
Your answer
Number of pregnancies *
Number of live births *
SUPPORT PERSON/PARTNERS INFORMATION
Use "N/A" if not applicable
First & Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
HELP ME GET TO KNOW YOU
These answers will help me understand how to best support you though this exciting journey.
Share briefly about your prior pregnancy, birth, and postpartum experience(s) and how you would like this experience to unfold: * *
Your answer
How do you (and your partner) feel about taking a childbirth education class? * *
Your answer
Have you taken childbirth education before? When and where? * *
Your answer
Is there anything else you would like me to know before class begins? * *
Your answer
CLASS INFORMATION
Class will be held online with the virtual live support occurring weekly using the Zoom platform. *Detailed information will be sent via email.

Each student will receive the class appropriate workbook along with personalized class handouts used during in-person classes.
What class are you registering for?
Do you have the free Zoom app downloaded to your phone, tablet, or computer?
*CLASS AGREEMENT*
Upon the submission of this intake and agreement you will receive an detailed email including an invoice. Once the payment is received in full your materials will be purchased and mailed to the address you provided.

You will be notified within reason of any postponements of our weekly Zoom meeting, typically 12 to 24 hours before the scheduled time.

Additional service discounts may vary based on your class participation.
Do you agree to the *Class Agreement*?
Are you interested in learning about any of the following services? Additional service discounts may vary based on your class participation. *
Required
How did you hear about us? *
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