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Natural Childbirth Class Registration

Step 1: Select & Purchase Your Class*

After you complete this step, you will be directed back to this page to complete step 2 of the registration process.

*Refund and cancellation policy: Satisfaction is guaranteed or your money back. Full or partial refunds for special circumstances are determined on a case-by-case basis. In the event a class series is canceled for any reason, full refunds will be issued.

Step 2: Complete & Submit Registration Form

Please complete the form below and click "submit registration." You will then receive your class confirmation.

You must complete steps 1 and 2 to register for the class.

Please feel free to contact me with any questions or concerns. You may reach me by phone at (219) 895-0118.

You won't regret making this vitally important investment in your birth and baby!

Class Registration

Please note that all fields followed by an asterisk must be filled in.

Please select class

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Home Phone*
Home Phone*

Cell/Alternate Phone

Occupation*
Occupation*

Partner's Name*
Partner's Name*

Estimated Due Date*
Estimated Due Date*

Birth Place*
Birth Place*

	Hospital
	Home
	Birth Center

If hospital or birth center, which one?

Prenatal Care Provider*
Prenatal Care Provider*

How you heard about the classes*
How you heard about the classes*

First pregnancy?

	Yes
	No

Names and ages of other children (if applicable)

Relevant information about you, your pregnancy and/or previous births?

What are your hopes and goals in taking these classes?

Allergies or special dietary concerns

Any additional comments or questions?

Please enter the word that you see below.

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The content of this website is provided for
general informational purposes only and is
not intended as, nor should it be considered
a substitute for, professional medical advice.

SBI!