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? MM slash DD slash YYYY Are you expecting a single baby or multiple? Singleton Twins Triplets Quadruplets or more Is this your first pregnancy? Yes No Please identify how much you trust the following resources for reliable prenatal information.Public health unit Do not trust at all Trust slightly Trust moderately Trust completely Do not know Primary care provider Do not trust at all Trust slightly Trust moderately Trust completely Do not know Health Canada Internet Do not trust at all Trust slightly Trust moderately Trust completely Do not know Chatrooms, discussion boards Do not trust at all Trust slightly Trust moderately Trust completely Do not know Family, friends Do not trust at all Trust slightly Trust moderately Trust completely Do not know Social media (Facebook, Twitter, blogs) Do not trust at all Trust slightly Trust moderately Trust completely Do not know Books, magazines Television, radio Do not trust at all Trust slightly Trust moderately Trust completely Do not know Other resources Do not trust at all Trust slightly Trust moderately Trust completely Do not know What 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 AvailableCAPTCHA
