Childbirth Education Class Sign up

Joys of Birth Childbirth Education Class

October 8th,15th & 22nd | 6:30pm - 9:00pm This class will meet at Louisville Family Chiropractic.
Mother's Name*

First NameLast Name
Mother's Phone

Area CodePhone Number
Mother's E-mail*
Father's Name

First NameLast Name
Father's Email
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Estimated Due Date*

MonthDayYear
Birth Place
Provider
# Pregnancy
# of Children
Pregnancy Information

The following questions are not required but will help us to be more helpful to you with the more information that we have.
Have you taken childbirth classes in the past?

YesNo
In what ways have you prepared for childbirth during this pregnancy? (Books, Movies, Websites, Classes)
What areas of pregnancy, childbirth and postpartum do you hope to learn about in class?
Do you have any fears, anxieties, or concerns about childbirth and if so, what are they?
What are your plans for coping and comfort during labor and birth?
How has your pregnancy been so far?
Do you plan to breastfeed?

YesNoMaybe
Any other information of concerns?
Registration for the class is not complete until payment is received. How would you like to make your payment? The cost of the class is $150. (This includes 1 guest)*
example: Cash, Venmo, Paypal
Promo Code
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Joys of Birth Childbirth Education Class