Infant CPR Course Enrolment Form

Baby Safety & 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:*

October 8, 2024 - 6pm - 9pmOctober 18, 2024 - 6pm-9pmOctober 26, 2024 - 4:30pm - 7:30pmNovember 5, 2024 - 6pm-9pmNovember 24, 2024 - 10:30am - 1:30pmDecember 8th, 2024 - 3:30pm - 6:30pmDecember 19th, 2024 - 6pm-9pmPrivate Class - In Person ($200)Private Class - Virtual Private ($150)Other
How did you find us?*
I understand that the class costs $80 (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

Let me get to know you! Please fill out this questionnaire. I will email you just prior to the class with parking instructions, location. what to bring, etc. You can pay on the website, www.denverbirthandwellness.com, click 'CPR/Choking & Baby Safety' than all the way 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 needs to be paid in full one week before the first day of class or you will be canceled. Feel free to talk to me about a payment plan if needed.
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Baby Safety & CPR/Choking Class Sign-up

Tell me about yourself!

Course Sign-up

Payment