PERSONAL INFO:

Full Name *

Email *

Phone *

City

Province/State

Postal code/Zip Code

Please tell us which class you prefer

Check your preferred class

Wednesdays 7-8:30pm

Saturdays 10-11:30am

Will you be attending alone or with a Birth Companion?

Alone

With a Birth Companion

PLEASE FILL IN THE INFORMATION BELOW

How may weeks pregnant are you currently?

What is your due date?

How many times have you given birth before?

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