Class Registration

Please leave a reply so that I may have a correct head count and don’t over-book the class.  A deposit of $150 is due with your registration form, the balance of $100 must be paid in full by first day of class.  I am open to payment arrangements if needed.  If you are using my services through the WIC program, Medicade, White Rose program, or Gabriel’s Angels program please include that in your reply so I can modify your registration form. 

Childbirth Class Registration Form

      
Your Name:                                                    Partner’s Name:
 
Today’s Date:                                                 Estimated Due Date:
 
Address:                                                         City:                                    Zip Code:
 
Phone(s): HM:                                                 Cell:                                     Work:
 
Email Addresses:
 
What is the best way to contact you?
 
Where are you giving birth?                                Care Provider’s Name:
 
How did you learn about Sweet birth 101 Birth Services?
(care provider/ friend/relative/ Internet)
 
Special Needs (food allergies, sign language, or health issues):
 
Date 8 week or 4 week class series begins (please specify 8 or 4 week):
For conformation receipt, do you prefer post mail or email (indicate one please):
 
$150.00 Deposit/ $250.00 full tuition

You may send it to me via snail-mail or email, your choice.  

Also, please fill out the childbirth questionnaire and have it at the first day of class! 

Childbirth Class Questionnaire

Your Name:                                           Partner’s Name:
                                                                                                                                                Estimated Due Date:

1. What is your age?                         

2. General health status?

3.  Do you exercise regularly?                                                                       

       What kind of activity?                        How often?

4.  Are you having any discomfort sleeping, or in general? 

5.  What are your expectations of your birth experience?

6.  What are some of your fears or concerns about your birth?

7.  How does your partner feel about attending an 8 or 4 week birth class?

8.  What do you hope to achieve through attending this class?

9.  How do you feel about your care provider?

10.  How has he/she inspired confidence in you and your partner?

11.  What do you know about breastfeeding?

12.  What are your plans for pain management?

13.  What are you views of labor induction?

14.  What are your views of fetal monitoring? 

Finally, please  click here    to print off a couple food journals.  Please bring with you a weeks worth of your food journal to the first day of class along with your balance of payment if any.