Childbirth Class Registration Class ChoiceClasses in Perry beginning February 11, 2025Which class series would you like to register for?Mother's Name *Mother's Email *Mother's PhonePartner's NamePartner's PhonePartner's Email AddressMailing Address *Mailing AddressApartment, suite, etcCityStateZIP CodeEstimated Due DateBirth PlaceWhere are you planning to give birth? (This information will help us prepare you best for labor and delivery options you will have.)ProviderWho is your birth provider? (doctor, midwife, etc.)# PregnancyHow many pregnancies have you had?# ChildrenDo you have any other children?Past ClassesYesNoHave you taken childbirth classes in the past?PreparationIn what ways have you prepared for childbirth during this pregnancy? (Books, Movies, Websites, Classes)Hope to LearnWhat areas of pregnancy, childbirth and postpartum do you hope to learn about in class?Coping PlansWhat are your plans for coping and comfort during labor and birth?Partner RoleHow do you see your partner's role during labor and birth?Pregnancy So FarHow has your pregnancy been so far?Biggest FearList or describe your biggest fear or anxiety related to pregnancy or labor and delivery.DoulaYesNoHaven't DecidedDo you have a doula?DietHow would you describe your diet? Any dietary restrictions?ExerciseYesNoSometimesDo you exercise regularly?BreastfeedingYesNoMaybeDo you plan to breastfeed?OtherAny other information or concerns?Class Terms & ConditionsTerms and ConditionsCancellation/Refund Policy: PayPal, Venmo, and credit card are acceptable forms of payment. Email me if you would prefer to pay by cash or check. Payment must be made in full 24 hours prior to the first day of class, unless other arrangements have been made. Returned checks will incur a $35 charge to cover associated fees. Cancellations prior to the first class date will result in a full refund minus $10 administration fee. Missed Classes: Any class missed will not be eligible for reschedule. If you need miss a class you must notify Anne Elliott at least 2 hours prior to the start of class so that the class may be recorded and sent to you. If you are unable to complete a class series due to delivery prior to 36 weeks gestation (and you were scheduled to complete the series prior to 36 weeks gestation), or due to bed rest or other serious illness, the remaining classes will be pro-rated and refunded. Otherwise, no refunds are offered for missed classes. A class may be canceled due to low enrollment. Every effort will be made to help you find a suitable replacement class. In the event of class cancellation, if no arrangement can be made, you will receive a full refund. In the event of class cancellation due to inclement weather or other unforeseen reasons, the class will be rescheduled at no additional cost. If no arrangement can be made, you will receive a refund for this class. Agree to Terms and ConditionsI agree with the terms and conditions.Please check your agreement with the terms and conditions.Register