Childbirth Class Registration

Childbirth and Infant Care/Lactation Class

Please complete this form to register and make payment. Future parent and one support person are allowed per reservation.
Future Parent's Name *

First NameMiddle InitialLast Name
Support Person (not required, but recommended.)

First NameMiddle InitialLast Name
Phone Number. Must accept text messages. We will text a confirmation, and details for the class.*

Area CodePhone Number
Alternate Phone Number*

Area CodePhone Number
Estimated Due Date for Current Pregnancy*

My Products

Childbirth Class only Saturday $100.00

9am to 4pm IN PERSON (Arlington office) We will break for lunch. Lunch is on your own.

Combo Saturday - Childbirth plus infant care and breastfeeding$175.00

9am-6pm : both Child Birth and Breastfeeding/infant care in one day. IN PERSON. We will break for lunch. Lunch is on your own.

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

We will send you a confirmation email.
Please type your email address.
I understand I am expected to bring these items.N/A - I did not register for the childbirth class
I agree with this payment policy.
Should be Empty:

Childbirth and Infant Care/Lactation Class