Class Online Registration « MamaAssist London, Ontario | Birth Doula Services, Bellycasting, Postpartum Support, Organic Products

Online Registration Form for Classes

Please fill out the form below entirely, and note that fields marked * are required information.

Advance payment is the only way to secure your spot in one of our classes. We accept PayPal or credit card payments online. We will contact you when we receive your registration to arrange payment and confirm your attendance. Classes fill up quickly so please register as soon as possible. Thank you!

Your Contact Information
Your Full Name*:
Street Address*:
City*:
Postal Code*:
Call Back Phone Number*:	Needed in case of class changes.
Alternate Phone Number:
Email Address*:	Will only be used to confirm payment and for contact with our staff. Your email address is safe with us!
Your Partner's Name:	(if applicable)
Pregnancy Information
Due Date*:
Have you given birth before?
Intended Place of Birth:
Midwife or Doctor's Name:
Class Information
Select class you are registering for*:
How many people will attend class with you?*	One partner is included, each additional participant is $10.
Please list names of any people coming with you to class:
Have you used any MamaAssist services before?	Yes No
How did you hear about MamaAssist?

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