birth class registration form birth class registration form Please choose which class you are registering for: * Thursdays: October 11 - November 8, 6:30-9:30pm, Del Mar Birth Center, Pasadena Weekend Intensive: October 13&14, 12-6pm, Eastside LA Weekend Intensive: December 8&9, 12-6pm, Eastside LA Private class with one doula educator: time, date, location TBD $495 Mom's Name: * Partner's Name: Partner's Relationship to Mom: Estimated Due Date: * Address: * Phone Number: * Alternate Phone Number: Mom's Email: * Partners's Email: OB/Midwife's Name: * Place Planned for Delivery: * Who is your doula if you are working with a doula? Do you have other children? * Yes No If Yes: How many & what are their ages? How did you hear about the class? * Describe any medical conditions we should be aware of: What is mom's greatest concern with pregnancy, labor, birth or postpartum? * What is partner's greatest concern with pregnancy, labor, birth or postpartum? * What do you hope to gain from this class? * *I have read and agree to the Terms & Conditions. * I agree Review the Terms & Conditions here. You will not be registered for your class until you have paid your deposit. Please see the below drop down menu for payment options via PayPal. If you would prefer to mail in a check, please contact email@example.com to receive further instructions. [paypal_wp_button_manager id=8712] Join the Community Community is a vital part of wellness for new and expecting families. Sign up for our newsletter to receive a monthly message from us with upcoming events. Join Welcome to the Two Doulas Birth Community.