Birth Boot Camp 2015 Fall Series Registration
Series Runs Sept 14 - Nov 16 on Monday Nights from 6:30-8:30pm
Mom's Name
Your answer
Dad's Name
Your answer
Address
Your answer
Email
Your answer
Phone Number
Your answer
Age
Your answer
Estimated Due Date
Your answer
Number of Pregnancies
Your answer
Number of Live Births
Your answer
Where do you plan to have your baby?
Who is your care provider?
Your answer
How did you hear about Country Bumpkin Birth Services?
Your answer
How do you feel about taking childbirth classes?
Your answer
How does your partner feel about taking childbirth classes?
Your answer
Do you have any specific goals related to your upcoming birth? If so, what are they?
Your answer
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