BIRTHING CENTER CLASS Info Request Form

First Name:
Last Name:
Phone Number:
Email:
Address:
City:
State:
Zip Code:
Due Date:
Where are you delivering your baby?
Classes Interested In: (Please select all that apply and choose what date you want to attend)
Preparing for Childbirth
Combo Fast-Track Childbirth Class
Cesarean Birth Education
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Try one FREE week of classes & gym time at the Bond Wellness Center: Just ask your doctor for a Wellness Center prescription.

Prenatal Aquatics: Members Fee: $5.00 / Non-Members Fee: $7.00
Classes taught by Birthing Center RN's - pregnancy, labor and delivery discussions after exercising in the warm therapy pool.

NOTE: Fees for classes

Check with your insurance carrier for reimbursement of class fees.

Financial Assistance available: Call 924-1717 and ask about the MCH Financial Grant Program. WIC and Medicaid Application/ Assistance available from Home Health Care and Community Services Prenatal Program: contact Holly Bee at: 603-352-2253

Combination Class Packages: take any 2 or more classes and take $10.00 off each class
(not including the Wellness Center Classes at this time or the Big Brother and Big Sister Sibling Class)

For more information on Bond Wellness Center classes please call 624-4650 or visit www.mchwellness.com.