Birth Class Registration Form

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Registering is a two part process. Please pay for the class package you want to take, then fill out this registration form. If you’ve already paid, please just fill out this form. If you’re taking multiple classes, you only need to fill out the registration form once. For questions, please Amanda at call 303.601.5689 or send an email to AmandaDean@pm.me.

Class start date *

YYYY

Birthing person's name (first & last) *

Street Address *

City *

State *

Zip code *

Birthing person's phone number *

Birthing person's email *

Due date *

YYYY

Birthing person's date of birth *

YYYY

Birthing person's usual weight *

Birthing person's occupation? *

Does the birthing person smoke? *

Yes

How did you find out about this class *

Google

Social Media

Doula/Practitioner

Friend/Family

Other:

What are you most interested in learning about? *

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