Booking Forms

Booking form: Click Here to download Booking form

Last name
First name
Date of birth
DD slash MM slash YYYY
NHI number*
Residential address
Mobile phone
Email address
Name of partner/support person/alternative contact
Ph number of partner/support person/alternative contact
Ethnicity
EDD (Expected Date of Delivery)
DD slash MM slash YYYY
Lead maternity carer
Expected place of delivery (birth)
Are you a 'first time' parent?
Which Series of class you do wish to attend? We recommend you attend around 26-28 weeks pregnant. Your preferred classes may not always be available but we will endeavour to cater for your requests as best we can 🙂
I give permission for Helensville Birthing Centre to contact me with a short survey regarding the Pregnancy and Parenting Classes*
- Yes
- No

I am*
- a parent, and live in South Kaipara
- a parent, and I have been cared for by a HBC Midwife
- a Health Care Professional. Please enter your contact details
- other
HCP name and contact details / 'other' explanation
First name
Last name
Address
Phone number
Email
Mother's Date of birth

Day
Month
Year
Mother's NHI number
Baby's name
Baby's date of birth

Day
Month
Year
Baby's NHI number
Reason for consult

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