Prep 4 Birth Registration
Welcome to Prep 4 Birth Childbirth Education series! I am looking forward to helping you prepare for this wonderful season of life. Upon receiving your registration I will send you an invoice that can paid via PayPal, check or cash. You will also receive a detailed email about the class! Thank you and feel free to contact me with any questions! Our time together will be wonderful!
Name of individuals attending class:
Your answer
Email address
Please enter the product number
Your answer
Telephone Number:
Your answer
How did you hear about Prep 4 Birth?
Your answer
Series you are registering for: (minimum of 4 couples)
Estimated Due Date:
MM
/
DD
/
YYYY
Place of Birth:
Care Provider:
Your answer
What number pregnancy is this for you?
Your answer
What level of exposure have you had to pregnancy and childbirth?
None, I am very unaware
I am very familiar and educated with the process
What level of anxiety/fear do you have towards labor and delivery? *
None
Very anxious and fearful
Are there any specific topics you hope to cover during our class?
Your answer
Briefly describe your birth goals/hopes:
Your answer
Method of payment you intend to use:
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