Birth And BeYond - Registration Form

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Interested in taking a course from Birth And BeYond? If so, simply fill out the form below, but be sure to mail a deposit cheque to Birth And BeYond so they can hold your spot.

If you prefer, you can send the registration form through mail. Simply click the link at the bottom of the page. Again, remember to send a deposit cheque.

Today's Date:
Due Date:
Expectant Mothers Name:
Age:
Address:	City/Town: Province: Postal Code:
Phone Number:
Email:
Occupation:
Names & Ages of other children:
Briefly describe previous birth experience(s):
Labour Partners Name:
Age:
Phone:
How did you learn about Birth and Beyond Classes?
Midwife/Doctors Name:
Baby's Doctor:
Where do you plan to give birth?
Are you planning on having a Doula at the birth?	Yes: No:
What is your choice of Feeding?	Breast: Bottle: Combination:
Do you have an infant car seat?	Yes: No:
Describe any conditions (medical or otherwise) you feel your educator should be aware of:
What is your greatest concern about this pregnancy, labour and birth?
What do you hope to gain from these classes?

Class Size is Limited so Please Submit This Form With $65 Non Refundable Deposit Fee to Hold Your Spot to:
Mélissa Cowl, 4257 Concession 5, R.R. #2, Loretto, ON L0G 1L0.

If you have any questions please feel free to contact Mélissa at 705.435.3715 or doula@sympatico.ca

If you would like to print out a copy of this registration form and send it through the regular mail, Click Here.

More Info

Class Description
Meet the Instructor
Registration Form