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Prenatal Class Registration Form
Registration Form
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* Indicates required question
Email
*
Your email
Name (First and Last)
*
Your answer
Do you plan to bring a partner, spouse or family member with you? If so, please list their name below.
Your answer
What is your complete address (include street number, the city & zip)
*
Your answer
Please list your phone number, just in case we have a few questions and need to call you.
*
Your answer
What is your date of birth?
*
MM
/
DD
/
YYYY
What is your due date?
*
MM
/
DD
/
YYYY
Early Prenatal Class
*
Choose
January 04
February 01
April 04
May 02
June 06
August 01
September 05
October 03
November 07
Not interested in attending this class
Baby Care Class
*
Choose
January 18
February 15
April 18
May 16
June 20
August 15
September 19
October 17
Not interested in attending this class
Breastfeeding Success Class
*
Choose
January 10
February 14
April 10
May 08
June 12
August 14
September 11
October 09
November 13
Not interested in attending this class
Breastfeeding Pump Class
*
Choose
January 24
February 28
April 24
May 22
June 26
August 28
September 25
October 23
November 27
Not interested in attending this class
Lamaze Classes (every Tuesday)
*
Choose
January 9, 16, 23, 30
February 06, 13, 20, 27
April 02, 09, 16, 23
May 07, 14, 21, 28
June 04, 11, 18, 25
August 06, 13, 20, 27
September 03, 10, 17, 24
October 01, 08, 15, 22
November 05, 12, 19, 26
Not interested in attending this class
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