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Register

Course:	Childbirth Education: 5-week seriesChildbirth Education: Weekend intensiveBreastfeedingNewborn CareComprehensive Package
Session:	June 27July 11July 25August 15August 29September 12October 3October 17
Sessions:	Childbirth Education: September 8 - October 6 June 11 - June 12July 9 - July 10July 23 - July 24August 13 - August 14August 27 - August 28September 10 - September 11October 1 - October 2October 15 - October 16 Breastfeeding: June 27July 11July 25August 15August 29September 12October 3October 17 Newborn Care: June 13June 27July 11July 25August 15August 29September 12October 3October 17
Mother's Name:
Partner's Name:
Address:
City:
Postal Code:
Home Phone #:
Work#:
Email Address:
Due Date:
Caregiver:	Midwife Doctor
Chosen Place of Birth:	Home Hospital if hospital, which one?
Do you plan to breastfeed or bottle feed?	Breast Bottle
Do you have any allergies?	Yes No if yes, please list them here
Are there any topics you would like to have included in your childbirth class?
Do you have any concerns for your upcoming birth:
Are there any physical or cultural considerations I should be aware of to ensure your comfort?
How did you hear about Childbirth Resource Room?
Do you wish to be on our mailing list for upcoming courses and events through Childbirth Resource Room (e.g. baby care, baby food, breastfeeding support)?	Yes No
How will you be paying?	PayPal Cash Check Paying by PayPal assures your spot in the class will be reserved immediately. When paying by cash, your payment must be delivered before your spot in the class is reserved. When paying by cheque, payment must be delivered before your spot in the class is reserved. Please make cheque payable to Tracey Sebastian.

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Payment

**NOTE: you will be registered for your childbirth class once payment is received. Registration is on a first come first serve basis. Once payment is received I will confirm your registration, including time and location, and provide you with details of the course.

We require full payment for your course 3 weeks in advance of the class to secure your spot. We accept payment in cash, or by check or PayPal. Payment can be delivered by mail, or you can drop it off at 428 Stirling Ave S. Kitchener, N2M 3H9.

Cancellation policy

A full refund is available if you cancel 3 weeks in advance of your course. No refunds will be available for cancellations less than 1 week before the class. There is a $35 non-refundable administration fee.

If your baby arrives before your scheduled class date you will be refunded the value of your course minus a $35 administration fee. Otherwise there will be no refund for cancellations within one week of the scheduled class date.

If you need to change your scheduled course date, Childbirth Resource Room will make every effort to switch you into an alternate class or offer you a private class for an extra fee of $75 payable immediately.

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About Childbirth Resource Room

The Childbirth Resource Room™ is a childbirth education and support facility serving Kitchener, Waterloo, Everton, Eden Mills, Dundas, Guelph, St. Marys, Avonton, Heidelberg, Elora, Stratford, Harmony, Baden, Cambridge, Shakespeare, Salem, St. Agatha, Inverhaugh, Brantford, Elmira, Brucedale, Mannheim, East Perth, Hamilton, Drumbo, West Montrose, Tavistock, Linwood, Woodstock, Ayr, Milton, Woolwich, St. Jacobs, Arthur, Wellesley, Wilmot, Puslinch, Ingersoll, North Dumfries, Eramosa, London, Toronto, Acton, Paris, Conestogo, Breslau, Fergus, North Oxford and the greater Southwestern Ontario area.

© 2007-2009 All rights reserved. Childbirth Resource Room, The Childbirth Resource Room design are trademarks of Childbirth Resource Room™