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Childbirth, Postpartum, and Newborn Care Class Registration
Please complete this form to register for an upcoming childbirth and newborn care series.
Self-paced breastfeeding course also included for families choosing to breastfeed.
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Registration for Class Series
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Pregnancy Resource Connection class series, Fridays (5:30 - 8:30 pm) and Saturdays (10:00 am - 1:00 pm) May 3, 4, 10, and 11
Hybrid (Virtual/In-person) Series: Wednesdays June 5 - June 26, In-person Thursday July 11, 2024 6:00 - 8:45 pm
Pre-Recorded hybrid series, 4 virtual recorded classes, 1 in-person meeting, personalized live virtual one-on-one meetings with Gina.
Private class
Your Estimated Due Date
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About You
Birthing mother's name
Your answer
Father or Partner name
Your answer
Who is your care provider? Where will you give birth?
Your answer
Best email addresses for class correspondence
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Your answer
Phone number
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Your answer
Background Information
What number pregnancy is this for you? Have you previously given birth? If yes, how old are your children?
Your answer
What are you looking forward to in birth?
Your answer
Do you have any fears/concerns about birth?
Your answer
Partner/Spouse attending birth?
Your answer
Any physical problems with this pregnancy?
Your answer
Have you experienced any pregnancy losses or fertility challenges? If so, how is this reflected in you during this current pregnancy?
Your answer
What have you read on pregnancy and birth?
Your answer
Why did you choose this particular course?
Your answer
About Your Birth
What is your vision for this birth?
Your answer
How do you feel about medical procedures/interventions in birth?
Your answer
How do you feel about natural (unmedicated/drug-free) childbirth?
Your answer
Are there any cultural or religious considerations that will be reflected in your birth?
Your answer
If safety were not a concern, what is your dream location for giving birth?
Your answer
How did you hear about this class?
Your answer
Other Comments?
Your answer
Thank you!
I look forward to seeing you in class!
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