Childbirth Education Class Registration

Mother's Name & Support Person/Husband: *

Phone: *

Email Address: *

What pregnancy is this for you?: *

Due Date: *

Doctor/Midwife: *

Have you had any problems with this or a previous pregnancy?: *

Session: *

Wednesday: January, 9, 16, & 23: 2013

Wednesday: March 6, 13, & 20: 2013

Wednesday: May 8, 15, 22: 2013

Wednesday: July 3, 10, 17: 2013

Wednesday: September 4, 11, & 18: 2013

Wednesday: November 6, 13, & 20: 2013

Please call the Birthing Center (419-678-5670) to cancel if you no longer wish to attend a class you signed up for. Registration for classes can also be done by calling the Birthing Center.

NOTE: All Childbirth Preparation Classes are held from 6:00- 8:30 PM.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.

Header Image:

Left Menu Navigation

Childbirth Education Class Registration