Manitoba Association for Childbirth & Family Education

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Title:
First Name:
Last Name:
Address:
City/Town:
Province:
Postal/Zip Code
Phone Number:
Email:
Class Name: View Prenatal Classes View Other Classes
Date of Class Series:
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 Payment Details on Next Page