EBB® Childbirth Class Registration

EBB® Childbirth Class Registration Form

Thank you for your interest in our Evidence Based Birth Childbirth Class- I'm looking forward to connecting! Please fill out this short form so that we can get started!
Name of Birthing Person

First Name Last Name
Estimated Due Date

Month Day Year
E-mail
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City Province

Postal Code
Partner/ Birth Partner's Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
General Information

Classes consist of max 6 couples. These questions will help me to accommodate schedules as best I can!
Please indicate below if you have particular times or days of the week that typically work best for you. Please check all that apply to maximize options.

Monday to Friday - daytime Monday to Friday - evening Weekend - daytime Weekend - evening
This class takes place over 6 weeks. Please let me know which start date works best for you:

April 29, 2020 May 14th, 2020 June 9th, 2020 July 8th, 2020 September 8th, 2020 October 20th, 2020
Is there anything else you'd like me to know about you before we get started? Any particular questions or concerns?
I will be in touch shortly! I'll send you a link to begin your EBB® "orientation" videos in advance of our first class. Should you have any questions, please contact Wanda at wandacox@eastlink.ca

Warmly, Wanda Cox

www.gracefulbeginnings.ca
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EBB® Childbirth Class Registration Form