Infant CPR Course Enrolment Form

Baby Safety, Infant Care & CPR/Choking Class Sign-up

Please fill out the form below and select the class you'd like to take. Payment instructions are at the bottom.
Tell me about yourself!
Mother/Person #1 Full Name*

First NameLast Name
Due Date

MonthDayYear
Date
Mother's/Person #1 Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityRegion

Post CodeCountry
Mobile Number*
Email Address*
Partner/support person name

First NameLast Name
Place of Birth*
Please list Home, Birth Center, Hospital - List the name as well. For example: St. Joes
Anything I should know about you or your situation or whatever?*
(Tell me whatever you'd like! Can I help you with anything?)
Anything you'd like to learn more about?*
(I want to make sure I cover what you'd like to know. If nothing new put 'no' or 'n/a')
This is my:*

First babySecond babyThird babyFourth +GrandparentBabysitter/NannyOther
Course Sign-up
Course Date to enrol:*

Private Class - In Person ($200)April 11th, 2026. 10:30am - 1pmOther
How did you find us?*
I understand that the class costs $45 (this includes handouts). Denver Birth and Wellness reserves the right to cancel, move, reschedule, or change the time, of a class or class series or end class early. (Although extremely rare). This charge in non-refundable. Thank you! You must pay in full one week prior to class or your spot will be released. I understand I do not get a CPR certificate out of this class. I can confirm I have read and accept all the terms and conditions of enrolment set out within this form:*

Yes
Payment

You can Venmo me @amandajhf (last 4 6359). I am having trouble fixing my payment site, so you can use Venmo or pay in class. Let me know if you have any questions! Please fill out this questionnaire. I will email you just before the class with parking instructions and the location. what to bring, etc. You can pay on the website www.denverbirthandwellness.com. Click 'CPR/Choking & Baby Safety,' then, at the bottom, you will see a "pay" button. Hit that, and you can pay. If you want to use an FSA/HSA, please email me at: denverbirth@gmail.com or call/text 970-302-6359. The course must be paid in full one week before the first day of class; otherwise, it will be canceled. Feel free to talk to me about a payment plan if needed.
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Baby Safety, Infant Care & CPR/Choking Class Sign-up

Tell me about yourself!

Course Sign-up

Payment