Childbirth Class Registration

Childbirth Class Registration
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last 4 digits of SSN
Martial Status
Race
Ethnicity
Religion
Employer
Emergency Name and Phone
Primary Physician
ie. Dr. Lastname
Office Location
Are You an Expectant Mother?
Where do you plan on delivering?

Other
Previous Maiden Name
Due Date

MonthDayYear
Date
Date of Last Menstrual Period

MonthDayYear
Date
OB Provider's Name
ie. Dr. Lastname
Office Location
ie. Trinity Medical OB/GYN
Payment Information

Please check one
Primary Insurance
Policy Number
Subscriber
Subscriber's Employer
Subscriber's Date of Birth

MonthDayYear
Date
Subscriber's Relationship to Patient
Group
Plan
Secondary Insurance
Policy Number
Medicare Number
Medicaid Number
Newborn Medicaid Number
Choose Your Classes
Visit chsbuffalo.org/childbirth-classes for available dates and times.
Select the Classes
Childbirth Classes
Classes for Baby Care and Family Safety
Specialty Classes
Visit https://www.chsbuffalo.org/childbirth-classes/active-comfort-techniques-for-labor-class/ to view the upcoming class schedule, and enter your preferences below.
Active Comfort Techniques for Labor - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Active Comfort Techniques for Labor - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/yoga/ to view the upcoming class schedule, and enter your preferences below.
Baby & Me Yoga - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Baby & Me Yoga - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/childbirth-education-series/ to view the upcoming class schedule, and enter your preferences below.
Comprehensive Childbirth - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Comprehensive Childbirth - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/hospital-tours/ to view the upcoming class schedule, and enter your preferences below. Prepared Childbirth classes offer an optional hospital tour. There is no need to request a hospital tour if you are registering for the Prepared Childbirth class.
Hospital Tour - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Hospital Tour - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/childbirth-education-series/ to view the upcoming class schedule, and enter your preferences below.
Lamaze Focus - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Lamaze Focus - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/yoga/ to view the upcoming class schedule, and enter your preferences below.
Prenatal Yoga - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prenatal Yoga - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-cesarean-delivery-class/ to view the upcoming class schedule, and enter your preferences below.
Prepared Caesarean Delivery - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Caesarean Delivery - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-childbirth-classes/ to view the upcoming class schedule, and enter your preferences below.
Prepared Childbirth - Activity- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Childbirth - Activity- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-childbirth-classes/ to view the upcoming class schedule, and enter your preferences below.
Prepared Childbirth - Basics - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Childbirth - Basics - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-partners-class/ to view the upcoming class schedule, and enter your preferences below.
Prepared Partners - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Partners - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/baby-talk-class/ to view the upcoming class schedule, and enter your preferences below.
Baby Talk - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Baby Talk - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/breastfeeding-class/ to view the upcoming class schedule, and enter your preferences below.
Breastfeeding - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Breastfeeding - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/child-safety-classes/ to view the upcoming class schedule, and enter your preferences below.
Car Seat Safety - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Car Seat Safety - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/child-safety-classes/ to view the upcoming class schedule, and enter your preferences below.
Infant and Child CPR - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Infant and Child CPR - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/gestational-diabetes-class/ to view the upcoming class schedule, and enter your preferences below.
Gestational Diabetes - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Gestational Diabetes - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/grandparents-class/ to view the upcoming class schedule, and enter your preferences below.
Grandparents - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Grandparents - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/healing-after-birth-class/ to view the upcoming class schedule, and enter your preferences below.
Healing After Birth - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Healing After Birth - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/multiple-miracles-class/ to view the upcoming class schedule, and enter your preferences below.
Multiple Miracles - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Multiple Miracles - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/natural-family-planning-class/ to view the upcoming class schedule, and enter your preferences below.
Natural Family Planning - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Natural Family Planning - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/nicu-higher-risk-moms-babies-class/ to view the upcoming class schedule, and enter your preferences below.
NICU/Higher Risk- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
NICU/Higher Risk- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/strong-family-foundations-class/ to view the upcoming class schedule, and enter your preferences below.
Strong Family Foundations- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Strong Family Foundations- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Additional Comments
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Childbirth Class Registration

Payment Information

Choose Your Classes