Whakatāne Antenatal Class Registration
These classes are funded by The Wright Foundation/The Village so information gathered on enrollment may be shared with them.
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Support person
First Name
Last Name
Support person Phone Number
Support person E-mail
example@example.com
Relationship to you
When are you expected to be 40 weeks?
*
-
Month
-
Day
Year
Date
Which class would you like to enroll for
Please Select
Sat October 25th and November 1st (9am-1:30pm)
Sat November 22nd & 29th (9am-1:30pm)
Who is your midwife?
What number pregnancy is this?
How did you hear about us?
*
Please Select
Midwife
The Wright Foundation
Word of Mouth
Other
If 'Other' please specify
Is there anything in particular that you would like to be covered?
Any comments or information you would like to share
What are you hoping to get out of antenatal classes?
Are you likely to be birthing in Tauranga?
Please Select
Yes
No
Unsure
Submit
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