Class Registration Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Partner's Name (if applicable)Estimated Due Date or Baby's Date of BirthWho is your caregiver (your midwife or doctor)?What class would you like to register for?* Weekly Childbirth Essentials Class Weekend Childbirth Essentials Class Early Parenting Essentials Class Private Childbirth Essentials Class Breastfeeding Essentials Class Mommy Connections Mom & Baby Class Which Mommy Connections Class do you want to register for?* Sign up for our wait-list Please let me know when another date is available. Which Breastfeeding Essential Class do you want to register for?* Please let me know when another date is available. Which Weekly Childbirth Essentials Class do you want to register for?* January 6th - February 17th, 2021(Wednesday)(7-9)(Arbour Birth Center) February 4th-March 18th, 2021 (Thursday's)(7-9 PM)(Arbour Birth Center) February 24th-April 7th, 2021(Wednesday)(7-9 pm)(Arbour Birth Center) March 9th-April 20th, 2021(Tuesday)(7-9)(Aurora Midwifery Clinic) March 7th-March 28th, 2021 (Sunday's)(5-8:30 PM)(Aurora Midwifery Clinic) Please let me know when another date is available. Which Weekend Childbirth Essentials Class do you want to register for?* November 28th/29th, 2020 VIRTUAL (9-1 PM) January 23rd & 24th, 2021 (9-4 PM)(Aurora Midwifery Clinic) March 7th-March 28th, 2021(5-8:30 pm)(Aurora Midwifery Clinic) March 13th & 14th, 2021(9-4 PM)(Arbour Birth Center Please let me know when another date is available. Which Early Parenting Essentials Class do you want to register for?* Please let me know when another date is available. How did you hear about us? *We'd love to say thank you!Is there anything you would like to ask or share before we talk?Terms and ConditionsI understand that submission of this registration form will secure a spot in my selected class. I also understand that it is my responsibility to contact Calgary Birth Essentials if I need to withdraw my registration (a non receipt of payment is not considered a withdrawal)Full payment must be received within 48 hours of registration. If the full payment is not received a deposit of 10% of the class total will be kept and the spot will be forfeited. If one decides to back out of their class a refund minus the deposit will be made if withdrawn with at least 3 weeks notice in advance of class start. If the request to withdraw is made less than 3 weeks before class start no refund can be made as there is more of a chance the spot will not be filled by someone else. (Withdraw due to medical reasons will be addressed on an individual basis.) So as to avoid participants registering and then not contacting us for withdraw, we will then be asking for payment from you either the full amount or the deposit amount depending on time of withdraw. This is to encourage participants to communicate effectively and respectfully with us. I have read and agree to the Terms of Service” CAPTCHANameThis field is for validation purposes and should be left unchanged.