Intro to Charting for Young Women

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Registration Form for the Intro to Charting for Young Women Class
For menstruating Young women Ages 9-15 and their Mothers or Female Mentors

Young Woman's Full Name (Client) *

Young Woman's Age *

Date of Birth *

YYYY

We would like to register for the following class *

July 15th, 2020 6:30-8:30PM

Mother/ Female Mentor Name *

Address (Street, City, ST. Zipcode) *

Phone number of Mother or Female Mentor *

Email of Mother or Female Mentor *

Date or estimate of first menstruation

YYYY

How did you hear about the Intro to Charting Class? *

Name of Family Doctor/ GYN *

Has the young woman ever had a GYN exam? *

If yes to question above, please share the date of exam

YYYY

What interests you most or what is you main reason for registering for this class?

Any Questions about the Intro to Charting for Young Women Class?

Important Information - Please Read before submitting form

Ashwood FertilityCare Center has developed a new program for Young Women who have begun their menstrual cycles (ages 9-15) and their mothers or female mentors .

We will present an introduction to observations and tracking menstrual cycles using a 1-year paper chart.
As an introduction to charting this will not be the full Creighton Model System and is not to be used for Family Planning. The Intro to Charting class will be a great transition to the full Creighton Model Charting System at the age of 16. A Chart Review with a FertilityCare Practitioner is optional but recommended when needed or seeking a NaPro Technology Referral.

Class topics will include:
Communication
Self Care/ SPICE
Female anatomy
Basic biomarker observations (period and cervical mucus)
Basic charting
Intro to NaPro Technology for single women (treatment for PMS, irregular cycles, PCOS, Endometriosis)
Health and Feminine Hygiene
Self-value and Respect

Please feel free to contact Kari Beadner, CFCP with any questions regarding the content of the Program

Intro to Charting for Young Women Registration includes:
2-hour class to be attended with Mother or other Female Mentor
1 paper chart to chart 1 year of cycles
Self Care and Communication materials
A personal Hygiene product kit (reusable cloth pad)

Fees for Intro to Charting for Young Women:

$40.00 Intro to Charting for Young Women group class and all materials
*additional sisters may attend together for $20 each

$30.00 per 30-minute chart review session (yearly/when needed or requested)

*Women ages 16-18+ would be encouraged to Register for the Introductory Session of the full Creighton Model FertilityCare System and to attend with a parent under the age of 18.

*After attending Intro to Charting Class there will be a $25 discount (for mom or daughter) when attending the full Introductory Session of the Creighton Model FertilityCare System.

Registration and payment for the Intro to Charting for Young Women class is required before attendance. You may submit this form and then use the following link to pay via Pay Pal (please choose friends and family) or send a check to:

Ashwood FertilityCare Center
211 Albany Ave SE
Orange City, IA 51041
(Please print client's name in memo)

paypal.me/ocfertilitycare/40

You will receive an email to confirm registration and payment has been received along with the location (or link) to attend the class. Please allow 2 business days for processing and then email ashwoodfertilitycare@gmail.com if you don't receive an emailed conformation.

I have read the above "Important Information" and agree to submitting payment to secure registration for class and materials *

Yes

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