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Maternity Class Registration Form



Classes meet in the Education Center, 2nd floor
Weekend and Evening parking in the garage - Follow signs to the Education Center or go to Campus Map

Registrant Information
* Required Fields
* Name:
* Address:
* City:   * State:   * Zip:
*One phone number is required
Home Phone:   Work Phone:
Email:
* Name of doctor (OBG): * Your Date of Birth: (MM/DD/YYYY)
* Delivering Hospital: * Due Date: (MM/DD/YYYY)
 
Maternity Tours
Some maternity tours occur multiple times a day. Please indicate the date(s) and time(s) you would like to take a Maternity tour. Please refer to the Maternity Tours page for current dates and times:
  Date: Time: #Attending
1st Choice
2nd Choice
 
Class Information
Please indicate the class(es) and date(s) you would like to attend:
Class 1st Choice
Date		 2nd Choice
Date		 # Attending
Having a Healthy Pregnancy
Anesthesia for Labor and Birth
Mom's Care & Recovery After Delivery
Breastfeeding
Caesarean-Section Class
Baby Talk (from a Baby Doctor)
** Infant CPR  ($15 per person) (Payment must accompany registration)
** Expectant Fathers Class
Labor Class
Basic Baby Care Course
** New Baby in Our Family
** Big Brother/Big Sister
The Joys of Grandparenting
** You must be delivering at Baptist Hospital East to attend this class
 
Sibling Information
Please list the name(s) of the sibling(s) planning to attend.
For Big Brother/Big Sister and New Baby in Our Family classes only.
Sibling Full Name Age DOB
Sibling Full Name Age DOB
Sibling Full Name Age DOB
Sibling Full Name Age DOB
 
Credit Card Information
NOTE: Credit card information is only necessary for those classes that require payment.
Only the Infant CPR class requires payment at time of registration.
Type:
Name on card:
Account Number (without spaces):
Expiration Date:  
Amount to be Charged: $
 
Additional Information
How did you learn about Baptist East Maternity classes?
Physician Radio Friend/Relative TV
Newspaper Baby Steps on Website Website Other
 
Comments
Do you have any additional comments?