Register for Classes (Form)

Register for Classes

Please fill out the form below to register for birth classes. If you would prefer a PDF file to download and print, click here.

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Due Date *

Labor and class partner's name (husband, friend, etc.) *

This is pregnancy number *

This is baby number *

Name of hospital or birth center (or homebirth) *

Name of Doctor/Midwife/Group *

Class Option *

Healthy Birth, Naturally - Group Healthy Birth, Naturally - Private Preparing for Baby, Home Edition

I prefer to pay via *

Check/Cash Paypal

Please make your check out to Kristen Woudstra and bring to the first day of class. If you prefer to use Paypal I will email instructions to you within 24 hours of receiving this registration.

Please list any topics that are of particular concern for this pregnancy *

How did you hear of Roots and Wings Birth Services? *

Comment *