Pregnancy and Parenting Class 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

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