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Ivinson Memorial Hospital

Prepared Childbirth Registration Form

Use this form to register for your IMH Prepared Childbirth class provided by the Family Care Center at IMH.
Please fill in all areas of the form below then click submit. You will be required to bring payment to the first class.
* First Name
* Last Name
* Age
* Due Date
* Address
* City, State, Zip Code
* Phone Number
Please include best one to reach you.
* Email Address
This will be used to confirm registration and provide pertinent information for your stay at IMH. Please use "none" if you don't have one.
* Occupation
* Name of Spouse or Support Person
Type "none" if this does not apply.
* Is this your first pregnancy? Yes     No    
* Have you had any problems with this pregnancy? Yes     No    
Class Selection
Select your preference for classes below. Select all that apply (for example Refresher class and Sibling class).
  Weekend Sessions
Cost is $50 per couple.
June 30-July1
August 4-5
October 20-21
December 1-2
  Teen/Single Sessions
Cost is $10 per participant. This class is arranged and taught as needed. You will be contacted to schedule a time.
  Sibling Class
Please provide names and ages of children attending the sibling class
  Sibling Class
Cost is $10 per child, $30 max per family. Please select number of children attending this class and provide names and ages above.
4 or more
  Refresher Class
Cost is $35 per couple.
  Breast Feeding Class
Breast feeding classes are free of charge. All classes are held at 6:30 PM.