The Breastfeeding Class with Illuminatal Doula Services
Please complete the information below to register for The Breastfeeding Class. Payment is due at the time of registration to secure your spot.
Full Name
*
First Name
Last Name
Spouse/Partner Name
*
First Name
Last Name
Relationship Status
*
Please Select
Married
Common Law / Partnered
Separated
Divorced
Other
None
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
E-mail
*
Due Date
*
Baby's Gender
*
Boy
Girl
Surprise
Where are you planning to give birth?
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Who is your care provider for this birth?
*
Who referred you to this class?
*
Have you breastfed in the past? For how long?
Please Select
Yes, less than 6 weeks
Yes, less than 6 months
Yes, 1 year or longer
No, attempted but not successful
No, never attempted
No, first baby
What questions or concerns do you have about breastfeeding?
Illuminatal offers a variety of classes for new and expectant parents. What other topics are you interested in?
*
preparation for natural childbirth
preparation for medicated childbirth
coping techniques and comfort measures for labor
the amazing placenta and its benefits
newborn care
vaccinations
circumcision
babywearing
car seat safety
baby health and wellness
baby gear and essentials
postpartum well-being
Additional Comments or Requests
I agree to pay $50 for the group class to be held at West University Wellness, 5180 Buffalo Speedway, Houston, TX. I understand that payment is due in full with registration. I understand that elements outside of Heather Barrett's control may cause a postponement of my class, including but not limited to births, illness, traffic, or weather. I understand that in the event of postponement, Heather will notify me as soon as possible. The Thursday following the class will be available for make-ups if any session is cancelled by Heather. I agree to release and hold harmless Heather Barrett and Illuminatal Doula Services from any claims that may arise from the class or any information taught therein.
*
I agree to the terms described above.
Class Payment - Payment screen will open after form submission.
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The Breastfeeding Class
$
50.00
Total
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0.00
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