Childbirth Class Registration
Email address *
Date of Class I am interested in attending:
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Full Name: *
Your answer
Phone Number: *
Your answer
Due Date: *
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DD
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YYYY
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). *
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