Breastfeeding Class Registration Form
All breastfeeding classes are held held on Sundays from 11:30am - 2:00pm at Prairie Ridge Health hospital in Columbus.
BREASTFEEDING CLASS (11:30am - 2:00pm)
June 21, 2026
August 2, 2026
September 20, 2026
November 15, 2026
Mother's Name
*
First Name
Last Name
Mother's Email
*
example@example.com
Support Person's Name
*
First Name
Last Name
Relationship
Please Select
Spouse
Significant Other
Family
Friend
Other
Your Doctor's Name
Due Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is this your first baby?
YES
NO
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
SUBMIT
Should be Empty: