Registration Form
Please print and fill out the entire form and mail it to Maureen with a deposit check.
Please email me or call me at (408) 629-6861, to get the address for where to send
your registration. Thank you!!
Mom's Name: ___________________________________________________
Coach's Name:___________________________________________________
Address: ______________________________________________________
City: ___________________ Zip: ___________ Due Date: _______________
Home Phone: _________________________ Day Time Phone: ______________
Email address: __________________________________________________
Dates of classes you wish to register for: ______________________________
Midwife or Doctor:_______________________________________________
Intended Birth Place: _____________________________________________
I understand that there are pets in the home that the classes are held _________