 |
|
Printer friendly Registration form. |
|
Your Name:__________________________________________________________________________
Partner’s Name:______________________________________________________________________
Will your partner be attending class?____________________________________________________
Address:____________________________________________________________________________
Phone (home, work, or cell):___________________________________________________________
Best Number to reach you at:__________________________________________________________
Email address:_______________________________________________________________________
Your estimated due date:______________________________________________________________
Is this your first child?_________________________________________________________________
Where are you intending to give birth? Hospital Home Undecided
Have you attended a birth before?_______________________________________________________
Anything else you’d like us to Know?
____________________________________________________________________________________
____________________________________________________________________________________
Include a $175 check or money order made out to:
Monica Liddle 31 W. Superior St. Suite 503 Duluth, MN 55802
Call Monica @ 428-0338 or Jana @ 340-2108 if you’d like to make payment arrangements. Thanks!
Download this form as a PDF
“Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their
inner strength.”
~Barbara Katz Rothman
|
