Childbirth Ed Registration

Name*

Email*

Phone*

Partner's Name*

Address

Estimated Due Date*

Place you intend to give birth?*

Choose Childbirth Education Class Option:*

4 week class - July/August 2023 at Bodywork in Richfield 4 week class - October/November 2023 at Rogue Awakening in Fairlawn Private Class

Choose Form of Payment*

Cash Venmo Check HSA/FSA Credit Card - (3% fee will be added) Credit Card - (3% fee will be added)