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Childbirth Education: Register

Indicates a required field

First Name

Last Name

Phone Number:

Partner / Support Person's Name:

Your Due Date:

Is this your first pregnancy?:

Yes

What 2 things do you hope to learn from this class:

Any special circumstances we need to know about:

Would you be willing to take a survey after class:

Yes

List other topics you may like to have covered:

We do not guarantee a successful registration in case of a concurrent request.