Childbirth and Infant Care class
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Email *
Date of Class I am interested in attending:
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Full Name:           *
What are you hoping to learn *
Phone Number: *
Due Date:                 Birthing Location: *
Are you financially eligible for WIC, or are you receiving any Social Services? *
Will a spouse, partner, or support person be attending with you? *
I understand that this class is provided at a rate of $250. Sliding scale available for those in need. Please indicate your need. I commit to attending this class, and if circumstances don't allow me to attend, I will email thebirthingcircle@gmail.com as soon as possible so my slot may be opened to another family. (Please type name as Signature). 
PayPal payment for class to:  Thebirthingcircle@gmail.com. 
The Birthing Circle is a 501c3 Not for Profit. You will be provided a receipt for tax and insurance purposes.
 *
Will you be using an FSA or HSA card and need a medical receipt? *
Would you like to be notified of our Community Baby Shower dates for attendance? *
Would you like to be notified of other related events available through The Birthing Circle? *
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