Registration Form — Great Beginnings

To make a booking, please fill in the form below, and I’ll get right back to you!

Name

First Name

Last Name

Course of interest?

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Dates of Workshop you wish to attend

YYYY

Birth Partner's name

First Name

Last Name

Due date?

YYYY

Do you have any other children?

Who is your OB/GYN?

Are there any medical problems, problems related to the pregnancy, feelings about the birth or any other information that you would like me to be aware of?

By completing this registration form for a Birth Matters Childbirth Education Workshop/Express Class, you consent to the collection of your information for contact, care management and statistical purposes in compliance with the Personal Information Protection Act 2016 (PIPA). Your personal contact details and other information gathered here will be used solely for these purposes and will not be shared with any unauthorized third parties without your explicit consent.

By completing this registration, for Birth Matters Workshops/Express and private classes, you acknowledge that these workshops are for educational and informational purposes only. They do not constitute medical advice. The information provided may or may not apply to your personal circumstances and pregnancy. You agree to use this information alongside your values, preferences, and clinical circumstances to make informed choices about your birth. These workshops also offer an opportunity to engage in meaningful conversations with your healthcare providers. By participating in the workshops, you release the facilitator from any responsibility for adverse outcomes resulting from your sole reliance on the information provided or any decisions you make regarding your healthcare.