Childbirth Education Class Sign up

Joys of Birth Childbirth Education Class

Saturday, September 6th | 8:30am - 12:30pm Saturday, September 13th | 8:30am - 12:30pm This class will meet at Louisville Family Chiropractic-Back Building
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. The cost of the class is $150. (This includes 1 guest) Please submit your payment via Venmo @JoysofBirth at least 48 hours prior to class.
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Joys of Birth Childbirth Education Class