Hospital Birth Class Registration Form
Hello! I look forward to having you in class. Classes are taught in American Fork, UT on Thursday evenings at 7pm. Please complete this registration form and I will be in touch with you shortly to confirm your registration and to give you all of the details. Thank you!
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Mom's First & Last Name
Partner's First & Last Name
Address
Email
Phone Number
Preferred Method of Contact
Mother's Age
Estimated Due Date
MM
/
DD
/
YYYY
Number of children
Where are you planning to have your baby?
Who is your care provider?
How do you feel about childbirth classes? What do you hope to learn?
How does your partner feel about taking a childbirth class?
Anything else you'd like me to know?
Which class dates would you like to register for?
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How did you hear about this class?
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