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Maternity Class Registration Form

We recommend that you print a copy of your selections from this page for your files.

Registrant Information
Name
Address
City State
Zip Country
Home Phone Work Phone
Email
OB/GYN Mother’s
Date of Birth
Delivering Hospital Due Date
Class Information
Please indicate the class(es) and date(s) you would like to attend:
Class 1st Choice
Date
2nd Choice
Date
# Attending
Prepared Childbirth Class-Saturday
Prepared Childbirth Class
Prepared Childbirth Refresher Class
Breastfeeding Class
Caesarean Birth Class
Sibling Class
Relaxing From Within
Grandparenting Class
Baby Care Basics
Baby Brunch / Infant Massage
Additional Attendant Information
Please list the name(s) of the additional guest(s) planning to attend.
For Sibling Class only.
1st Attendant Full Name Age DOB
2nd Attendant Full Name Age DOB
3rd Attendant Full Name Age DOB
4th Attendant Full Name Age DOB
Additional Information
How did you learn about our maternity classes?
Physician Health Source
Friend/Relative Maternally Yours Program
Newspaper Baptist Health Line
Other  
Comments
Do you have any additional comments?

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