Name *
Name
Phone
Phone
Labor Support's Name
Labor Support's Name
Date of first class
Date of first class
Your Age
Your Age
Your Address
Your Address
Due Date
Due Date
(do you need frequent breaks? Or is there a specific situation about your pregnancy you'd like me to be aware of?)
What other services are you interested interested in learning about?
Check all that apply
Do you want to receive Birthing Confidence's Newsletter? *
Consent for pictures *
I sometimes take pictures or short videos to include on Lamaze DC and Birthing Confidence's website and social media properties. Please let me know if you consent to pictures or video being taken during class. (Please answer for both you and labor partner - if one doesn't consent you both don't consent.