Please complete the following information for our class list.Your information will not be shared with any outside parties.
Mother's first name:
Mother's last name:
Partner's first name:
Partner's last name:
Address 1:
Address 2:
City:
Province: British ColumbiaAlbertaYukonNorth West TerritoriesSaskatchewanManitobaOntarioQuebecNewfoundlandNew BrunswickNova ScotiaPEINunavitNon-Canadian
Postal Code:
Email Address:
Day-time phone #:
Evening phone #:
Due-date (dd/mm/yy):
First Baby? YesNo
Please select a class from the drop-down menu below.
Class Dates: Private classes: (three 2-1/2 to 3-hour online video-conference sessions). Pls. call or email to arrange dates.Summer Workshop #1: Sundays July 10th and 17th, PLUS Monday evening July 18th * ONLINE *Summer Workshop #2: Sundays August 14th and 21st, PLUS Monday evening August 22nd * ONLINE *Summer Workshop #3: Sundays September 11th and 18th, PLUS Monday evening September 19th * ONLINE *Fall Workshop #1: Sundays October 16th and 23rd, PLUS Monday evening October 24th * ONLINE *Fall Workshop #2: Sundays November 13th and 20th, PLUS Monday evening November 21st * ONLINE *Fall Workshop #3: Sundays December 11th and 18th, PLUS Monday evening December 19th * ONLINE *Summer Series #1: Tuesdays, July 12th through August 23rd. * ONLINE *Summer Series #2: Tuesdays, September 13th through October 25th. * ONLINE *Fall Series #1: Tuesdays, November 1st through December 13th. * ONLINE *
Preferred method of payment: PayPal (you do not need to be a PayPal member)Cheque (by mail)Email transfer
Payment for private classes is made at either the first or second session.
Where do you plan to give birth?HospitalHome
Choose hospital: ---Abbotsford Regional HospitalB.C. Women’s HospitalBurnaby General HospitalLangley Memorial HospitalLions Gate HospitalPeace Arch HospitalRichmond General HospitalRidge Meadows HospitalRoyal Columbian HospitalSt. Pauls HospitalSurrey Memorial Hospital
Other hospital:
Plans for your birth?
Doctor or Midwife's name (or name of practice):
Medical complications (if any):
How did you find these classes?InternetDoctorMidwifeBrochureReferral from friend
Comments/requests: