Registration - Private Home Classes Mother's Name First Last Mother's AgePartner's Name First Last Partner's AgeAddress Street Address City Province Postal Code PhoneEmail Name of Doctor or Midwife First Last What is your expected due date? Date Format: MM slash DD slash YYYY Are you expecting a single baby or multiple?SingletonTwinsTripletsQuadruplets or moreIs this your first pregnancy?YesNoPlease identify how much you trust the following resources for reliable prenatal information.Public health unitDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowPrimary care providerDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowHealth Canada InternetDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowChatrooms, discussion boardsDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowFamily, friendsDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowSocial media (Facebook, Twitter, blogs)Do not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowBooks, magazines Television, radioDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowOther resourcesDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowWhat was the main reason(s) you chose an in-person or online prenatal education program?Do you have any medical concerns or questions you would like to discuss before your session?Are there any class topics you haven't seen on the list, that you would like to include?OptionChoose One1 8hr day - $4502 4hr days - $500Subtotal $ 0.00 CAD HST $ 0.00 CAD Total $ 0.00 CAD Free Parking Available
