Childbirth Class Registration 4 week childbirth classBlended Lamaze & Hypnobirthing techniquesCome learn everything pregnancy, birth and postpartum! Childbirth Class RegistrationFull NameEmailPartner's Name (if applicable)Phone NumberEstimated Due Date1st, 2nd, 3rd Pregnancy?Any Medical Condition/ConcernName/Title of ProviderDesired Birth LocationWhat are you hoping to get out of this childbirth class?Do you agree to pay the amount of $250 (or agreed upon amount) for this childbirth course? Payments can be made via Venmo @Patience-Dominick or cash upon arrival. *Payment plans are available I Agree Need Payment PlanSubmit Full Name Email Partners Name (if applicable) Phone Number Estimated Due Date 1st, 2nd, 3rd Pregnancy? Any Medical Condition/Concern Name/Title of Provider Desired Birth Location What are you hoping to get out of this childbirth class? Do you agree to pay the amount of $250 (or agreed upon amount) for this childbirth course? Payments can be made via Venmo @Patience-Dominick or cash upon arrival. *Payment plans are available I Agree Need Payment Plan Submit