Comfort Techniques in Labor Class Registration
Event Address: 127 Albany Ave SE, Orange City, IA
Contact us at: siouxlandchildbirtheducation@gmail.com

Pre-registration is required to attend class. Please be sure that you receive a confirmation email that your registration has been received. $40

I would like to register for class on the following date: *
Full Names of Attendees *
Your answer
Woman's Date of Birth *
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Email *
Your answer
Phone Number *
Your answer
Address *
Your answer
Have you ever given birth before? *
If you have given birth before, did you have any complications in any of your previous births? *
Your answer
How many children do you have?
Your answer
When is your estimated due date? *
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DD
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YYYY
How well do you feel your knowledge of the birth process is? *
Where will you be giving birth? *
Your answer
What do you hope to learn from this class? *
Your answer
How did you hear about this class? *
Your answer
Are there any other classes you would be interested in signing up for if available?
Do you need childcare for other children during class?
I understand that a payment of $40 will be due before arrival and may be sent directly to the instructor via PayPal address www.paypal.me/amarisgarcia/40 (Please choose PayPal option, "send to friends and family") *
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