Birthing by Design's Childbirth Classes
Name
*
First Name
Last Name
Partner's Name (If applicable)
First Name
Last Name
Is your partner attending class with you?
Yes
No
Unsure
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email/ Verify Email
*
Confirmation Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Partner's Phone Number (if applicable)
-
Area Code
Phone Number
Due Date (MM/DD/YYYY)
*
-
Month
-
Day
Year
Date
What number baby is this?
*
What gender is baby?
Team Pink
Team Blue
Team Green
Team Don't know yet!
Where do you plan to birth?
*
Sister's
Mercy
Oishei
Suburban
Lockport
Niagara Falls Memorial
Mt. St. Mary's
Batavia
Birth Center
Home birth
Other
Undecided
Who is your Doctor or Midwife?
*
Who is your Doula? (If applicable)
Which Class were you interested in?
Christ Centered Childbirth ($250)
Date Night Class ($200)
Comfort Measures ($75)
VBAC Class ($100)
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