Birth Prep Class Registration Form

Enroll now in the In-Person Class on November 2, 2024 (SAT), 9:30 AM @ KBC!

Enroll now in the Online/On Demand Class now...Click Here!

The In-Person class is in HIGH demand and will SELL OUT, so make sure to sign up NOW!

"Pelvic Floor Birth Prep Class"

For Pregnant Mamas (2nd to 3rd Trimester)

Option 1

Option 2

9:30 am to 11:00 am (Sat)

Online, Anytime (Pelapy.com)

Katy Birth Center

Select an opt-in notification preference.*

Let me know when the next class date is released and send me a discount code.Let me know when the next class date is released (only).
Which class location are you interested in? (select all that apply)*

Sugar Land, TXKaty, TXOnline/On-Demand
Class Date*
Full Name*

First NameLast Name
E-mail*
example@example.com
Cell Phone Number*
Partner's Name*

First NameLast Name
Will your partner attend the class?*

YesNo
Provider Name (OB/Midwife) *

First NameLast Name
Estimated Due Date*

MonthDayYear
Date
How many times have you been pregnant?*
How many children do you have?*
How did you hear about this class? Select all that apply.*

FriendMidwifeOnline AdSocial MediaWebsiteOther
Have you taken a birth prep class in the past?*

YesNo
How often do you exercise?*

None1-2 times weekly3-4 times weekly5-6 times weekly
If you do not exercise, please share why. If you do exercise, please describe how you exercise. (if using an online program, paste a link to the online resource that you use)
How have you prepared for childbirth during this pregnancy? [respond "none" if necessary] (Books, Movies, Websites, Classes)*
What areas of pregnancy, childbirth and postpartum do you hope to learn about in this class?
What questions do you have about your pelvic floor related to birth prep/postpartum? (Your questions may be answered during the class)
I understand that payment for this class is non-refundable.*

Yes
Signature*

Powered by Jotform SignClear

My Products*

Individual Registration (1 Person)

$115.00

Couples Registration (2 People)

$180.00

Enter coupon

Total

$0.00