Childbirth Education Class Registration Form


The information you provide here will help me to get acquainted with you before our sessions. Any medical or very personal info you choose to share will be kept confidential. If there is anything you'd prefer to share or discuss by phone with Lisa, feel free to call 646.249.9010. Thank you for taking the time to answer these questions.

Class Start Date *
Class Start Date
Note: please type first name as you prefer to be called on name tag
Note: please type first name as you prefer to be called on name tag
Does Attending Partner plan to provide labor support to pregnant parent? *
Best Phone to Text/Call *
Best Phone to Text/Call
Alternate Phone
Alternate Phone
Baby gender *
Please give specific hospital/birth center name or indicate "home" if home birth
Are you planning to use a labor support doula? *
Are you planning to use a postpartum doula? *
(for group classes only; private clients please enter NA)
Photography Release: Birth Matters NYC reserves the right to take photographic images of attendees during class for use in future promotional materials. By registering for class, you agree to allow use of the images for such purposes. *