Class Registration Sheet
Please complete this form to register for Group Childbirth and / or Breastfeeding & Newborn Care Classes!
Your name: *
Your answer
Partner or Support Person's name:
Your answer
Are you a patient of Olympia Obstetrics & Gynecology?
If "no" to the above, who is your prenatal provider?
Your answer
Your estimated due date: *
MM
/
DD
/
YYYY
Have you given birth previously?
Email address: *
Your answer
Phone number: *
Your answer
Your address:
Your answer
Doula:
Your answer
Please complete the following to register for Childbirth Education Class:
Please select a class:
Cost: $130 for four week series on Tuesdays from 6 - 8pm at Olympia Obstetrics OR $100 for a one day class on Saturday from 9:30am - 4pm.
Please rate your confidence level regarding labor, birth, and postpartum:
Please rate your confidence level regarding labor, birth, and postpartum:
not confident
most confident
What is important for you to learn from this class?
Your answer
Do you have any special circumstances you'd like me to be aware of? (multiples, high risk pregnancy...)
Your answer
Please complete the following to register for Breastfeeding & Newborn Care:
Please select a class:
Cost: $30 for 1 evening class ($20 if you're you're registering for childbirth education as well) Class meets Tuesday from 6 - 8:40pm at Olympia Obstetrics.
Who will be attending the lactation class?
Prices are per couple and partners are welcome and encouraged to attend. This question just helps me to prepare with the right number of chairs for our group. You're always welcome to let me know if your response changes before class!
Please rate your confidence level regarding breastfeeding & newborn care:
not confident
most confident
What is important for you to learn about breastfeeding & newborn care?
Your answer
Payment
Payment is due on or before the first day of class.
Please select a payment method:
I am happy to provide a detailed receipt upon request!
Any other comments you'd like to share:
Your answer
I have read and agree with the Cancellation / No Show / Refund Policy. *
If you've prepaid for classes and are unable to attend, the instructor will refund your registration less a $10 processing fee. Cancellations must be received at least one week prior to the first day of class in order to be eligible for a refund. Please allow up to two weeks for your refund to be processed. If you cancel less than one week prior to the first day of class you are not eligible for a refund.​ If you "no-show" for a class you've registered for and have not given prior notice to the instructor you will be responsible and invoiced for the full class fee. ​In the rare case of inclement weather, or instructor emergency or illness when a substitute is not available, classes may be cancelled. Every effort will be made to provide as much notice as possible and to schedule a make up class as soon as possible. In cases where a make up class is not possible, a partial or full refund may be available.
Required
Finally, how did you hear about Foveo Birth & Baby classes? *
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