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 free of charge and provided by The Mental Health Association and The Birthing Circle. By submitting this application, 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). *