The Dad's Class Registration Form

Please fill in all fields.

First Name of Father-to-be:
Last Name of Father-to-be:
Address:
City/Town:
Province:	Please Select Alberta British Columbia Manitoba Newfoundland/Labrador New Brunswick Northwest Territories Nova Scotia Nunavut Ontario PEI Quebec Saskatchewan Yukon Territory
Postal/Zip Code
Phone Number:
Email:
Date of Class:	Choose Date Sept.18, 2011 6-10 pm Nov. 20, 2011 6-10 pm
Number & Ages of Children:
Are there any concerns with the pregnancy, labour or birth?
What would you like to learn?
We recommend reading Fathers to Be by Patrick Houser.	Have you read Fathers to Be? Yes No Are you planning to read Fathers to be prior to attending the class? Yes No
How will you be paying?	Mail in payment PayPal
	Payment Details on Next Page