Register

Full Name:

Email:

Partner's Name (if applicable):

Street Address:

City:

Province:

Postal Code:

Phone Number:

Due Date:

Where are you having your baby?

Which Program did you want to register for?

Doctor's name or midwife practice:

Is this your first baby? If no, please list the number of previous births:

Please tell us your age:

Do you speak English? Please list other languages you speak:

Do you want to Breastfeed your Baby?:

Do you have plans for the use of medications in labour? Please tell us your thoughts. It's ok if you aren't sure:

Do you have any health issues or cultural issues that we should know about? If so, please tell us so we can do our best to accommodate them:

I agree to the terms of service, including the cancellation policy found here: birthdoulaprogram.ca/terms

Anything else you'd like to share with us: