Class enrollment: Breastfeeding Empowered : Confidence Together and TummyTime! Method™ 
I am looking forward to meeting you at the class. Please fill out the following form to enroll
Sign in to Google to save your progress. Learn more
Email *
Which Class or classes are you signing up for today?
Please note class dates are subject to change. You will receive email notification.
Adults Names Please include any adults planning to attend *
Baby's Name
Birth Date of Baby or Due Date  *
Phone Number *
Email address if different from current email
Prices are: $120/4 classes for TTM, $200 for BE:CT/8 weeks, $80 for BE:CT repeat. Today I am paying for  *
Payment Options *
Cancellation Policy- Class Fee less 10% will be refunded before the start of the first class. You are welcome to attend make up sessions in future sessions. *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Janet Fishstrom Dombro, IBCLC. Report Abuse