Class Registration Form

Please fill in all fields.

Title:	Select One Mr. Mrs. Dr. Prof. Ms. Rev. Miss
First Name:
Last Name:
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:
Class Name:	Choose Class Birthing From Within Private Class $175 Inspired Childbirth Preparation/Happiest Baby Class $125 Inspired Childbirth Preparation $125 Inspired Childbirth Preparation Condensed Class $125 The Second Time Around $75 The Second Time Around Private Class $125 Sibling Prep Private Class $50 Private Refresher/VBAC Class $100
Date of Class Series:	Choose Date ↓ Birthing From Within Classes ↓ Birthing From Within Private Class ↓ Inspired Childbirth Preparation Six Week Series ↓ September 15th to October 20th 2010 January 18th to February 15th 2011 March 2nd to April 6th 2011 June 13th to July 6th 2011 September 8th to October 13th 2011 November 2nd to December 7th 2011 ↓ Inspired Childbirth Preparation Weekend Classes ↓ September 11th and 12th 2010 October 23rd and 24th 2010 November 13th and 14th 2010 December 11th and 12th 2010 January 22nd and 23rd 2011 February 19th and 20th 2011 March 19th and 20th 2011 April 16th and 17th 2011 May 14th and 15th 2011 June 18th and 19th 2011 July 9th and 10th 2011 August 27th and 28th 2011 September 17th and 18th 2011 October 15th and 16th 2011 November 19th and 20th 2011 December 3rd and 4th 2011 ↓ Inspired Childbirth Preparation Condensed Classes ↓ September 26th 2010 ↓ The Second Time Around ↓ October 2nd November 21st December 11th February 5th 2011 April 16th 2011 June 11th 2011 August 27th 2011 October 29th 2011 December 3rd 2011 Sibling Prep Private Class
Who will be accompanying you to class?	No accompaniment
Do you plan to have any additional Labour Support?	Yes No If so, who?
Due Date:
Caregiver (doctor or midwife):
Baby’s Expected Place of Birth:
Mother's age:
Number of Previous Births:
Numbers & Ages of Children:
Are you planning:	An unmedicated birth? To breastfeed?
How did you hear about MACFE Prenatal Classes?
Have you attended prenatal classes before?	Yes No If so, where?
What topics are you concerned about and therefore would like to see covered in class?
Do you have any concerns regarding your pregnancy? Give details if you wish.
Do you have any concerns regarding labour or birth? Give details if you wish.
Have you read any books about childbirth or childcare, which you found useful? (Please list)
How will you be paying?	Mail in payment PayPal
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