|
CHILDBIRTH EDUCATION ASSOCIATION · PO BOX 58573, CINCINNATI,
OHIO 45258-0573 Mother's Name Birthing Partner's Name Address City State Zip Home Phone Work Phone Mother's Age Due Date Dr's Name Hospital to be delivered # of previous pregnancies Location & starting date you plan to attend: Time: Special circumstances regarding pregnancy For Instructors use only 1 2 3 4 5 6 Fee ___________ Date Paid _________ I heard about these classes through Doctor Advertisement Friend Other ____________________________ No refunds. Transfer requests granted only when received 1 week prior to start of the original class and availability permits. A $10 handling fee will be charged. |