Charlevoix Area Hospital - Charlevoix, East Jordan & Boyne City, Michigan

Birthing Class Online Registration Form
Once you have reviewed the class schedule and
selected the classes and series you want to take, just
complete this form and submit it below.

Name*		Home Phone*
Street Address*		Work Phone*
City*		Email Address
Zip*		Date of Birth*
Due Date*		Coach or Partner*
Doctor*		Is this your first baby?*	Yes No
Date of last delivery (if applicable)
	* indicates a required field
Please select which class you want to take and the series you prefer:
Countdown to Childbirth		Brush Up for Baby

BirthClasses08 BirthRegForm08