Sign me up for Black Families Childbirth Series
*= required field
First Name *
Last Name *
I prefer to be contacted by: *
What clinic are you going to for your prenatal care?
When is your due date? *
Will this be your first child? *
Did you attend a childbirth class with your other children? *
Will your main support person attend with you? *
If yes, what is their name?
Will you be bringing other children with you? *
If yes, how many and what ages.
Are you open to eating with this group? *
If yes, please list any dietary restrictions you have?
What transportation will you use for commuting to and from your class? *
I have a car, a ride, or other means of transportation to get to my class
I will need help with transportation
Thank you for completing this form!