Your Best Birth Childbirth Class Registration
Please fill out all fields and press send.

Cost per couple -
Complete 4 class series - $225

All classes are held at Legacy Life Center in East Brunswick , NJ on Sunday afternoon and run from 1:00 - 3:45 PM.

Non-refundable $75 deposit is due upon registration to hold your spot in the class. You can mail in a check or pay by paypal.(Paypal link will be sent in separate email within 48 hours) Balance is due at your first class. Receipts are available for flexible spending accounts, upon request.

Questions? Contact Jessica at or 732-925-3035

Your Name (First and Last) *
Your answer
Class Registration - Birth Basics 101 *
Classes can be taken in any order. Check one class for each section .
Class Registration - Comfort Measures *
Class Registration - The Hospital Experience *
Class Registration - Life After Baby *
Partner's Name
Your answer
Due Date *
Your answer
Cell Phone *
Your answer
Mailing Address *
Your answer
Email *
Your answer
City, State, and Zip Code *
Your answer
Obstetrician or Midwife's Name *
Your answer
Birth Location - Name of Hospital or Homebirth *
Your answer
Any Previous Births? *
Do you plan to breastfeed or bottle feed? *
Have you had any medical complications with this pregnancy? *
If you answered "Yes" above, please describe
Your answer
What are your goals in taking this class? *
Your answer
What class topics are most important to you? *
Your answer
How did you hear about our classes? *
Your answer
What method of payment will you be using for your $75 deposit? *
Thank You For Registering!
We're looking forward to seeing you in class. Your balance will be due at the first class. You will receive more information a week before your first class.

PLEASE NOTE: Your registration is NOT complete until we receive your $75 non-refundable deposit.

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service