Nurture & Nourish: Breastfeeding Education for Families - Class Registration Form
Join us for an afternoon of breastfeeding education for the family! In our Breastfeeding Education for Families course, you and your support persons will leave with the most updated information to have the best start at breastfeeding!

Go beyond the hospital's breastfeeding class and learn about everything from nutrition during pregnancy, to preparing for breastfeeding in the hospital, and everything about getting to know your baby and their breastfeeding needs. Our comprehensive curriculum is condensed down into a quick 3 hour class, with each hour discussing what breastfeeding is like in the real world (see description at our website at www.nurtureomaha.com/breastfeeding-education). Total class time is 3 hours.

Insurance may cover. If insurance does not the class is $75/couple.
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Email *
Lactating Parent's Name *
Name of Support Person Attending (spouse, parent, grandparent, etc)
Your support person may be anyone in your support circle who will be caring for the child, but not a friend who also has children (they will have to pay for an additional class). We highly encourage couples to attend this event, or the two main caregivers of the children. You get one additional person for free, and if you want to add on others past that it is $10/caregiver (ie., nanny, another grandparent, daycare provider, etc).
When is your due date? *
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What class would you like to attend? *
All classes are held the following Sunday from 1pm-4pm at our office located on 83rd & Cass. If a class is full, you will be contacted about alternative dates.
Dietary restrictions or allergies:
We provide light snacks and refreshments, so we like to ask about allergies/restrictions to accommodate everyone. But, please feel free to bring your own food to class.
Are you self-pay or using insurance? *
If you are self-pay, PayPal invoices will be sent within 48 hours of us receiving this response - your payment is your final way to secure your spot in this class. If you are using insurance, but your insurance denies the claim, you will be sent a PayPal invoice for the cost of the class once we receive word that your insurance was denied.
If you have a free class code please enter it here:
I understand that class space is limited and filling out this registration form does not guarantee me or my support persons a spot in the class I have selected above. *
We will always provide families with the education they desire. If a class is full we will work with registrants on finding another time/day to hold another class.
I understand and agree to the insurance/payment policies described below: *
I understand total payment is expected for this class upon the receipt of invoice, which if I am self-pay I will receive within 48 hours of filling out this form. If filing with insurance, I understand I am responsible for the full balance of any denied claims. I understand that it is my responsibility to understand my insurance's policies and what is covered. I understand that in-network status does not guarantee coverage of Nurture Omaha's services. I understand that Nurture Omaha may check with my insurance company if services are covered, but that answer does not guarantee payment. Optional equipment: Breastfeeding accessories may be recommended by the LC to facilitate progress and are optional, some of which may be covered by insurance. I understand that I am responsible for the full cost of anything my insurance does not cover. Please call Nurture Omaha, LLC for questions about all fees: (402) 915-1559.
No-show policy *
I understand that I may cancel my registration no later than 24 hours before the event. I understand that if I do not show up to this class that I will be billed for the full amount of the class, regardless of if I were using insurance benefits. If I contact Nurture Omaha within 24 hours of the start time of this class then I will be eligible to reschedule to another class or book a private class with Nurture Omaha. If I am a no-show or if I cancel with less than 24 hours from the start time of my chosen class, I understand I will be billed for the full cost of the class ($25).
By typing my FULL name below I understand that this is my electronic signature. I certify that all of the information provided in this form was correct. I agree to all policies listed above, If I selected "No" as a response to the three questions above then I understand that Nurture Omaha will deny all services to myself and my child(ren) until I agree to all policies. *
After you sign this form you will be sent a link to fill out our Patient Information Form. Once you fill out that form you will be fully registered for the class (space permitting, if class is full you will be contacted about an alternative class day/time).
A copy of your responses will be emailed to the address you provided.
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